Provider Demographics
NPI:1891722609
Name:EYE MDS OF PUGET SOUND PLLC
Entity Type:Organization
Organization Name:EYE MDS OF PUGET SOUND PLLC
Other - Org Name:NARROWS EYE SURGERY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BLACKWELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-442-2234
Mailing Address - Street 1:4707 S 19TH ST
Mailing Address - Street 2:SUITE 210
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1151
Mailing Address - Country:US
Mailing Address - Phone:253-272-4600
Mailing Address - Fax:253-272-6289
Practice Address - Street 1:4707 S 19TH ST LOWR LEVEL
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1157
Practice Address - Country:US
Practice Address - Phone:253-442-2234
Practice Address - Fax:253-752-8800
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-27
Last Update Date:2024-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
4040NAOtherBLUE SHIELD
WA7132640Medicaid
P00160625OtherRAILROAD MEDICARE
WAG8808497Medicare PIN