Provider Demographics
NPI:1851338255
Name:SOLE EXPRESSIONS
Entity Type:Organization
Organization Name:SOLE EXPRESSIONS
Other - Org Name:ISLAND CREST FOOT AND ANKLE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:G
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-275-9705
Mailing Address - Street 1:8015 SE 28TH ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-2910
Mailing Address - Country:US
Mailing Address - Phone:206-275-9705
Mailing Address - Fax:425-484-6425
Practice Address - Street 1:8015 SE 28TH ST
Practice Address - Street 2:SUITE 310
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-2910
Practice Address - Country:US
Practice Address - Phone:206-275-9705
Practice Address - Fax:425-484-6425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-02
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPO00000743213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU95913Medicare UPIN
WAU96196Medicare UPIN
WAG8853444Medicare ID - Type Unspecified