Provider Demographics
NPI:1992040240
Name:RETINA SPECIALISTS NORTHWEST, PLLC
Entity Type:Organization
Organization Name:RETINA SPECIALISTS NORTHWEST, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MYERS POWELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:253-517-3334
Mailing Address - Street 1:33915 1ST WAY S
Mailing Address - Street 2:STE 120
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-4551
Mailing Address - Country:US
Mailing Address - Phone:253-517-3334
Mailing Address - Fax:253-517-5695
Practice Address - Street 1:33915 1ST WAY S
Practice Address - Street 2:STE 120
Practice Address - City:FEDERAL WAY
Practice Address - State:WA
Practice Address - Zip Code:98003-4551
Practice Address - Country:US
Practice Address - Phone:253-517-3334
Practice Address - Fax:253-517-5695
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-27
Last Update Date:2020-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty