Provider Demographics
NPI:1689695231
Name:AESTHETIC EYE ASSOCIATES AMBULATORY SURGERY CENTER PLLC
Entity Type:Organization
Organization Name:AESTHETIC EYE ASSOCIATES AMBULATORY SURGERY CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:JANET
Authorized Official - Middle Name:
Authorized Official - Last Name:JORDAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:425-216-7200
Mailing Address - Street 1:625 4TH AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-9028
Mailing Address - Country:US
Mailing Address - Phone:425-216-7200
Mailing Address - Fax:425-216-7272
Practice Address - Street 1:625 4TH AVE
Practice Address - Street 2:STE 301
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-9028
Practice Address - Country:US
Practice Address - Phone:425-216-7200
Practice Address - Fax:425-216-7272
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:AESTHETIC EYE ASSOCIATES PS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-07-21
Last Update Date:2013-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA261QS0132X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8905884OtherPTAN