Provider Demographics
NPI:1770241424
Name:SEHOME EYE CARE, PLLC
Entity Type:Organization
Organization Name:SEHOME EYE CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRYAN
Authorized Official - Middle Name:T
Authorized Official - Last Name:REDICK
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:206-941-0401
Mailing Address - Street 1:1800 S JACKSON ST APT 546
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-2188
Mailing Address - Country:US
Mailing Address - Phone:206-941-0401
Mailing Address - Fax:
Practice Address - Street 1:302 36TH ST
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-6580
Practice Address - Country:US
Practice Address - Phone:360-363-0360
Practice Address - Fax:360-363-0160
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-11-30
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1013393933Medicaid