Provider Demographics
NPI:1790750313
Name:SEDRO WOOLLEY VISION CENTER INC
Entity Type:Organization
Organization Name:SEDRO WOOLLEY VISION CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:BEE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:360-855-1251
Mailing Address - Street 1:PO BOX 348
Mailing Address - Street 2:
Mailing Address - City:SEDRO WOOLLEY
Mailing Address - State:WA
Mailing Address - Zip Code:98284-0348
Mailing Address - Country:US
Mailing Address - Phone:360-855-1251
Mailing Address - Fax:360-855-2843
Practice Address - Street 1:823 MURDOCK ST
Practice Address - Street 2:
Practice Address - City:SEDRO WOOLLEY
Practice Address - State:WA
Practice Address - Zip Code:98284-1451
Practice Address - Country:US
Practice Address - Phone:360-855-1251
Practice Address - Fax:360-855-2843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-02-17
Last Update Date:2012-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00000994152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA057746001OtherGROUP HEALTH
WA2005353Medicaid
WA001100174Medicare PIN
WAT02912Medicare UPIN
WA2005353Medicaid