Provider Demographics
NPI:1760539969
Name:DR TIFFANY J HOLLENBECK PLLC
Entity Type:Organization
Organization Name:DR TIFFANY J HOLLENBECK PLLC
Other - Org Name:REDMOND RIDGE EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIFFANY
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOLLENBECK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:425-898-9222
Mailing Address - Street 1:22310 NE MARKETPLACE DR
Mailing Address - Street 2:SUITE 106
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98053-2038
Mailing Address - Country:US
Mailing Address - Phone:425-898-9222
Mailing Address - Fax:425-898-9225
Practice Address - Street 1:22310 NE MARKETPLACE DR
Practice Address - Street 2:SUITE 106
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98053-2038
Practice Address - Country:US
Practice Address - Phone:425-898-9222
Practice Address - Fax:425-898-9225
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3825152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
U99927Medicare UPIN
U98206Medicare UPIN