Provider Demographics
NPI:1922633270
Name:MILL CREEK FAMILY EYEWEAR
Entity Type:Organization
Organization Name:MILL CREEK FAMILY EYEWEAR
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:A
Authorized Official - Last Name:DAVIS
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:425-481-4440
Mailing Address - Street 1:16708 BOTHELL EVERETT HWY STE 103
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-6345
Mailing Address - Country:US
Mailing Address - Phone:425-480-3111
Mailing Address - Fax:425-481-4450
Practice Address - Street 1:16708 BOTHELL EVERETT HWY STE 103
Practice Address - Street 2:
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-6345
Practice Address - Country:US
Practice Address - Phone:425-481-4440
Practice Address - Fax:425-481-4450
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEVEN A. DAVIS. O.D., P.S.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-03-06
Last Update Date:2020-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1619060936OtherNPI