Provider Demographics
NPI:1700070158
Name:SEQUIM VISION CLINIC PS
Entity Type:Organization
Organization Name:SEQUIM VISION CLINIC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DEE
Authorized Official - Middle Name:
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-683-3389
Mailing Address - Street 1:PO BOX 549
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-0549
Mailing Address - Country:US
Mailing Address - Phone:360-683-3389
Mailing Address - Fax:360-683-7069
Practice Address - Street 1:541 NORTH 5TH AVENUE
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382
Practice Address - Country:US
Practice Address - Phone:360-683-3389
Practice Address - Fax:360-683-7069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-29
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA601357086152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACS1723OtherRR MEDICARE GROUP ID#
WACS1723OtherRR MEDICARE GROUP ID#
WAG115142900Medicare PIN