Provider Demographics
NPI:1245525336
Name:ISLAND FAMILY EYECARE, P.C.
Entity type:Organization
Organization Name:ISLAND FAMILY EYECARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:DR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:W
Authorized Official - Last Name:BRASE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:206-842-2015
Mailing Address - Street 1:164 WINSLOW WAY W
Mailing Address - Street 2:
Mailing Address - City:BAINBRIDGE ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98110-2512
Mailing Address - Country:US
Mailing Address - Phone:206-842-2015
Mailing Address - Fax:206-842-3047
Practice Address - Street 1:164 WINSLOW WAY W
Practice Address - Street 2:
Practice Address - City:BAINBRIDGE ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98110-2512
Practice Address - Country:US
Practice Address - Phone:206-842-2015
Practice Address - Fax:206-842-3047
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-16
Last Update Date:2011-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3687152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WATO 2882Medicare UPIN