Provider Demographics
NPI:1023043445
Name:AESTHETIC EYE ASSOCIATES, PS
Entity type:Organization
Organization Name:AESTHETIC EYE ASSOCIATES, PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:J
Authorized Official - Last Name:LAUKAITIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-216-7200
Mailing Address - Street 1:625 4TH AVE
Mailing Address - Street 2:SUITE 301
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-9028
Mailing Address - Country:US
Mailing Address - Phone:425-216-7200
Mailing Address - Fax:425-216-7272
Practice Address - Street 1:625 4TH AVE
Practice Address - Street 2:SUITE 301
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98033-9028
Practice Address - Country:US
Practice Address - Phone:425-216-7200
Practice Address - Fax:425-216-7272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2015-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207W00000X
WAASF.FS.60099157261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory SurgicalGroup - Single Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7121049Medicaid
WAGAB36305OtherPTAN
WAGAB36305Medicare PIN