Provider Demographics
NPI:1891820411
Name:PEARSON, ALAN PHILIP (OD)
Entity Type:Individual
Prefix:DR
First Name:ALAN
Middle Name:PHILIP
Last Name:PEARSON
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 1:12835 NE BEL RED RD
Mailing Address - Street 2:STE 303
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2631
Mailing Address - Country:US
Mailing Address - Phone:425-213-1016
Mailing Address - Fax:425-949-4491
Practice Address - Street 1:12835 NE BEL RED RD
Practice Address - Street 2:STE 303
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98005-2631
Practice Address - Country:US
Practice Address - Phone:425-213-1016
Practice Address - Fax:425-949-4491
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2057152W00000X
WA00002057152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1046093Medicaid