Provider Demographics
NPI:1922246024
Name:BELLA VISION CORPORATION
Entity Type:Organization
Organization Name:BELLA VISION CORPORATION
Other - Org Name:BELLA VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:ICHOL
Authorized Official - Middle Name:DERRICK
Authorized Official - Last Name:CHOE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:425-881-6655
Mailing Address - Street 1:8862 161ST AVE NE
Mailing Address - Street 2:SUITE 105
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-7553
Mailing Address - Country:US
Mailing Address - Phone:425-881-6655
Mailing Address - Fax:425-974-7440
Practice Address - Street 1:8862 161ST AVE NE
Practice Address - Street 2:SUITE 105
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-7553
Practice Address - Country:US
Practice Address - Phone:425-881-6655
Practice Address - Fax:425-974-7440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-27
Last Update Date:2009-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA602049389261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty