Provider Demographics
NPI:1821131848
Name:TOWN CENTER EYE CARE, LLC
Entity Type:Organization
Organization Name:TOWN CENTER EYE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LISA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:DEPIETTO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:425-357-0508
Mailing Address - Street 1:15118 MAIN STREET
Mailing Address - Street 2:SUITE 600
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-1653
Mailing Address - Country:US
Mailing Address - Phone:425-357-0508
Mailing Address - Fax:
Practice Address - Street 1:15118 MAIN STREET
Practice Address - Street 2:SUITE 600
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-1653
Practice Address - Country:US
Practice Address - Phone:425-357-0508
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty