Provider Demographics
NPI:1942962402
Name:SEA FAMILY VISION CLINIC, PLLC
Entity Type:Organization
Organization Name:SEA FAMILY VISION CLINIC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAVATEI
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:SEA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:206-940-0723
Mailing Address - Street 1:21005 44TH AVE W STE 102
Mailing Address - Street 2:
Mailing Address - City:MOUNTLAKE TERRACE
Mailing Address - State:WA
Mailing Address - Zip Code:98043-3584
Mailing Address - Country:US
Mailing Address - Phone:425-775-7144
Mailing Address - Fax:425-673-7885
Practice Address - Street 1:21005 44TH AVE W STE 102
Practice Address - Street 2:
Practice Address - City:MOUNTLAKE TERRACE
Practice Address - State:WA
Practice Address - Zip Code:98043-3584
Practice Address - Country:US
Practice Address - Phone:425-775-7144
Practice Address - Fax:425-673-7885
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-12
Last Update Date:2021-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2010382Medicaid