Provider Demographics
NPI:1013052885
Name:VALLEY EYE & LASER CENTER, INC
Entity Type:Organization
Organization Name:VALLEY EYE & LASER CENTER, INC
Other - Org Name:EYE TO EYE OPTICAL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:NORMAN
Authorized Official - Last Name:JOOS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-255-4250
Mailing Address - Street 1:17916 TALBOT ROAD SOUTH
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055
Mailing Address - Country:US
Mailing Address - Phone:425-277-6595
Mailing Address - Fax:425-430-9486
Practice Address - Street 1:17916 TALBOT ROAD SOUTH
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98055
Practice Address - Country:US
Practice Address - Phone:425-277-6595
Practice Address - Fax:425-430-9486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA0016846156FX1100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1100XEye and Vision Services ProvidersTechnician/TechnologistOphthalmicGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0429290001Medicare NSC
AB14142Medicare PIN