Provider Demographics
NPI:1699841361
Name:JON C CONVERSE INC PS
Entity Type:Organization
Organization Name:JON C CONVERSE INC PS
Other - Org Name:BINYON EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT OPTOMETRIST
Authorized Official - Prefix:
Authorized Official - First Name:JON
Authorized Official - Middle Name:CHARLES
Authorized Official - Last Name:CONVERSE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:206-622-4828
Mailing Address - Street 1:1905 4TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101
Mailing Address - Country:US
Mailing Address - Phone:206-622-4828
Mailing Address - Fax:504-910-0693
Practice Address - Street 1:1905 4TH AVENUE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101
Practice Address - Country:US
Practice Address - Phone:206-622-4828
Practice Address - Fax:504-910-0693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-27
Last Update Date:2007-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2019255Medicaid
U60618Medicare UPIN