Provider Demographics
NPI:1942399860
Name:STEPHEN GOO, OD, PS
Entity Type:Organization
Organization Name:STEPHEN GOO, OD, PS
Other - Org Name:AK EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:G
Authorized Official - Last Name:GOO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:206-523-6676
Mailing Address - Street 1:8032 35TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-4815
Mailing Address - Country:US
Mailing Address - Phone:206-523-6676
Mailing Address - Fax:206-523-7900
Practice Address - Street 1:8032 35TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-4815
Practice Address - Country:US
Practice Address - Phone:206-523-6674
Practice Address - Fax:206-523-7900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-11
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3262152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8858289Medicare PIN