Provider Demographics
NPI:1770580086
Name:OVERLAKE EYECARE, P.S.
Entity type:Organization
Organization Name:OVERLAKE EYECARE, P.S.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:PEI-AQQNN
Authorized Official - Last Name:CODAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-643-2020
Mailing Address - Street 1:1837 156TH AVE NE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-4387
Mailing Address - Country:US
Mailing Address - Phone:425-643-2020
Mailing Address - Fax:425-643-0859
Practice Address - Street 1:1837 156TH AVE NE
Practice Address - Street 2:SUITE 201
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-4387
Practice Address - Country:US
Practice Address - Phone:425-643-2020
Practice Address - Fax:425-643-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-01
Last Update Date:2025-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
No152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic SurgeryGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0149521OtherWA L&I GROUP NUMBER
WA2025047Medicaid
WA6478610001Medicare NSC
WA2025047Medicaid