Provider Demographics
NPI:1982814075
Name:OPTOMETRIC CENTER OF SEATTLE
Entity Type:Organization
Organization Name:OPTOMETRIC CENTER OF SEATTLE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:KEITH
Authorized Official - Last Name:SEWELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:206-325-1100
Mailing Address - Street 1:124 21ST AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-5912
Mailing Address - Country:US
Mailing Address - Phone:206-325-1100
Mailing Address - Fax:206-324-7641
Practice Address - Street 1:124 21ST AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5912
Practice Address - Country:US
Practice Address - Phone:206-325-1100
Practice Address - Fax:206-324-7641
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA251V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251V00000XAgenciesVoluntary or Charitable
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA205600Medicaid