Provider Demographics
NPI:1295014041
Name:BRIGHT EYES, INC.
Entity type:Organization
Organization Name:BRIGHT EYES, INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JUSTIN
Authorized Official - Middle Name:
Authorized Official - Last Name:JUE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:206-355-0282
Mailing Address - Street 1:11314 NE 124TH ST
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-4303
Mailing Address - Country:US
Mailing Address - Phone:425-821-5050
Mailing Address - Fax:425-821-0508
Practice Address - Street 1:11314 NE 124TH ST
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-4303
Practice Address - Country:US
Practice Address - Phone:425-821-5050
Practice Address - Fax:425-821-0508
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-11
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD60017736152W00000X
WAOD60095437152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1528296811OtherNPI - INDIVIDUAL