Provider Demographics
NPI:1699817346
Name:CASCADE EYE & SKIN CENTERS PC
Entity Type:Organization
Organization Name:CASCADE EYE & SKIN CENTERS PC
Other - Org Name:CASCADE LASER & SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:BUSINESS OPERATIONS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:JELMBERG-BRAYTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-446-3904
Mailing Address - Street 1:1703 S MERIDIAN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-7590
Mailing Address - Country:US
Mailing Address - Phone:253-770-7708
Mailing Address - Fax:253-770-7630
Practice Address - Street 1:1703 S MERIDIAN STE 201
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98371-7590
Practice Address - Country:US
Practice Address - Phone:253-848-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601325507261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7079189Medicaid
WA111019OtherWA. STATE LABOR & INDUSTR
WAG115000987Medicare ID - Type Unspecified