Provider Demographics
NPI:1972989069
Name:SHORELINE EYECARE PC
Entity Type:Organization
Organization Name:SHORELINE EYECARE PC
Other - Org Name:ERIKA TYDOR OD
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ERIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:TYDOR
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:314-541-6529
Mailing Address - Street 1:2558 76TH AVE SE APT 371
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-3785
Mailing Address - Country:US
Mailing Address - Phone:314-541-6529
Mailing Address - Fax:
Practice Address - Street 1:18021 15TH AVE NE
Practice Address - Street 2:SUITE 100
Practice Address - City:SHORELINE
Practice Address - State:WA
Practice Address - Zip Code:98155-3806
Practice Address - Country:US
Practice Address - Phone:206-367-8883
Practice Address - Fax:206-913-2915
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-07-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60293866152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty