Provider Demographics
NPI:1740558642
Name:CLEAR SIGHT NORTHWEST, PS
Entity type:Organization
Organization Name:CLEAR SIGHT NORTHWEST, PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KURT
Authorized Official - Middle Name:J
Authorized Official - Last Name:HOFELDT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:636-359-2159
Mailing Address - Street 1:10700 SE 208TH ST
Mailing Address - Street 2:SUITE 205
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98031-5545
Mailing Address - Country:US
Mailing Address - Phone:253-852-2120
Mailing Address - Fax:253-373-0201
Practice Address - Street 1:10700 SE 208TH ST
Practice Address - Street 2:SUITE 205
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98031-5545
Practice Address - Country:US
Practice Address - Phone:253-852-2120
Practice Address - Fax:253-373-0201
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD60102590152W00000X, 152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty