Provider Demographics
NPI:1801409677
Name:CENTRAL WASHINGTON EYE CLINIC PLLC
Entity Type:Organization
Organization Name:CENTRAL WASHINGTON EYE CLINIC PLLC
Other - Org Name:WASHINGTON VALLEY EYE SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:ABEL
Authorized Official - Middle Name:W
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-255-4250
Mailing Address - Street 1:427 SW 41ST ST
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-4926
Mailing Address - Country:US
Mailing Address - Phone:425-255-4250
Mailing Address - Fax:
Practice Address - Street 1:427 SW 41ST ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-4926
Practice Address - Country:US
Practice Address - Phone:425-000-0000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTRAL WASHINGTON EYE CLINIC PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-31
Last Update Date:2021-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic SurgeryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1841239399OtherREGENCY