Provider Demographics
NPI:1659671782
Name:POLARIS EYECARE INC
Entity type:Organization
Organization Name:POLARIS EYECARE INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BRETT
Authorized Official - Middle Name:D
Authorized Official - Last Name:LLEWELLYN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:206-625-9061
Mailing Address - Street 1:342 15TH AVE E
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-5103
Mailing Address - Country:US
Mailing Address - Phone:206-625-9061
Mailing Address - Fax:206-726-6056
Practice Address - Street 1:342 15TH AVE E
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-5103
Practice Address - Country:US
Practice Address - Phone:206-625-9061
Practice Address - Fax:206-726-6056
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-22
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA3212TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty