Provider Demographics
NPI:1659441160
Name:NORTHWEST VISION INSTITUTE, PLLC
Entity Type:Organization
Organization Name:NORTHWEST VISION INSTITUTE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:L
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-450-2020
Mailing Address - Street 1:12301 NE 10TH PL STE 200
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2487
Mailing Address - Country:US
Mailing Address - Phone:425-450-2020
Mailing Address - Fax:425-688-0620
Practice Address - Street 1:12301 NE 10TH PL STE 200
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2487
Practice Address - Country:US
Practice Address - Phone:425-450-2020
Practice Address - Fax:425-688-0620
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-09
Last Update Date:2010-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00027511207W00000X
WABG0163446332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
No332H00000XSuppliersEyewear SupplierGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAB65137Medicare UPIN
WAGAB22156Medicare PIN
WA4476410001Medicare NSC