Provider Demographics
NPI:1811040058
Name:ADACHI, PETER KEN (OD)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:KEN
Last Name:ADACHI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 UNIVERSITY ST
Mailing Address - Street 2:SUITE 824
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98101-1176
Mailing Address - Country:US
Mailing Address - Phone:206-622-2993
Mailing Address - Fax:206-622-7838
Practice Address - Street 1:600 UNIVERSITY ST
Practice Address - Street 2:SUITE 824
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98101-1176
Practice Address - Country:US
Practice Address - Phone:206-622-2993
Practice Address - Fax:206-622-7838
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1529152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAT01497Medicare UPIN