Provider Demographics
NPI:1972844652
Name:BURIEN EYECARE CENTER
Entity Type:Organization
Organization Name:BURIEN EYECARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF OPTOMETRY
Authorized Official - Prefix:
Authorized Official - First Name:JATINDER
Authorized Official - Middle Name:
Authorized Official - Last Name:BANSAL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:425-749-6766
Mailing Address - Street 1:625 SW 153RD ST
Mailing Address - Street 2:
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-2216
Mailing Address - Country:US
Mailing Address - Phone:206-242-8545
Mailing Address - Fax:206-244-2020
Practice Address - Street 1:625 SW 153RD ST
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-2216
Practice Address - Country:US
Practice Address - Phone:206-242-8545
Practice Address - Fax:206-244-2020
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-06
Last Update Date:2013-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00004053152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2012279Medicaid