Provider Demographics
NPI:1700995461
Name:SANKEY, GREGORY THOMAS
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:THOMAS
Last Name:SANKEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10212 5TH AVE NE
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-7452
Mailing Address - Country:US
Mailing Address - Phone:206-522-4222
Mailing Address - Fax:206-525-1496
Practice Address - Street 1:10212 5TH AVE NE
Practice Address - Street 2:SUITE 210
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-7452
Practice Address - Country:US
Practice Address - Phone:206-522-4222
Practice Address - Fax:206-525-1496
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOS00000012156FX1700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1700XEye and Vision Services ProvidersTechnician/TechnologistOcularist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA37189OtherLABOR & INDUSTRY PROVIDER
AKPO4547Medicaid
WA344581001OtherGROUP HEALTH COOP
AKPO45471OtherALASKA MEDICAID #
WA9033929Medicaid
WA911508025OtherFEDERAL TAX ID#
WA8917595OtherCRIME VICTIMS
WACU0117OtherREGENCE PROVIDER #
WA911508025OtherFEDERAL TAX ID#