Provider Demographics
NPI:1457740987
Name:RENTON VISION CLINIC PLLC
Entity Type:Organization
Organization Name:RENTON VISION CLINIC PLLC
Other - Org Name:RENTON VISION CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER / MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:NASIM
Authorized Official - Middle Name:
Authorized Official - Last Name:JAVAHERI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:425-228-3364
Mailing Address - Street 1:3218 NE 12TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98056-3405
Mailing Address - Country:US
Mailing Address - Phone:425-228-3364
Mailing Address - Fax:425-228-3378
Practice Address - Street 1:3218 NE 12TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98056-3405
Practice Address - Country:US
Practice Address - Phone:425-228-3364
Practice Address - Fax:425-228-3378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-21
Last Update Date:2015-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD60166211152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty