Provider Demographics
NPI:1255518239
Name:EVERGREEN EYE CARE, LLC
Entity type:Organization
Organization Name:EVERGREEN EYE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SUZANNE
Authorized Official - Middle Name:T
Authorized Official - Last Name:ZAMBERLAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:360-573-3937
Mailing Address - Street 1:1319 NE 134TH ST STE 107
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-2718
Mailing Address - Country:US
Mailing Address - Phone:360-573-3937
Mailing Address - Fax:360-574-3290
Practice Address - Street 1:1319 NE 134TH ST STE 107
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685-2718
Practice Address - Country:US
Practice Address - Phone:360-573-3937
Practice Address - Fax:360-574-3290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-22
Last Update Date:2019-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD3902152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6212060001Medicare NSC
WAV00389Medicare UPIN