EYE ASSOCIATES NORTHWEST, PLLC

Provider Demographics

• NPI: 1811952815
• Name: EYE ASSOCIATES NORTHWEST, PLLC
• Entity type: Organization
• Organization Name: EYE ASSOCIATES NORTHWEST, PLLC
• Other - Org Name: <UNAVAIL>
• Authorized Official - Title/Position: CREDENTIALING MANAGER
• Authorized Official - First Name: ROSA
• Authorized Official - Middle Name: ANGELICA
• Authorized Official - Last Name: CAMPOS
• Authorized Official - Phone: 206-215-2004
• Mailing Address - Street 1: 1101 MADISON ST
• Mailing Address - Street 2: SUITE 600
• Mailing Address - City: SEATTLE
• Mailing Address - State: WA
• Mailing Address - Zip Code: 98104-1306
• Mailing Address - Country: US
• Mailing Address - Phone: 206-215-2020
• Mailing Address - Fax: 206-215-2022
• Practice Address - Street 1: 1101 MADISON ST STE 600
• Practice Address - City: SEATTLE
• Practice Address - State: WA
• Practice Address - Zip Code: 98104-1340
• Practice Address - Country: US
• Practice Address - Phone: 206-215-2020
• Practice Address - Fax: 206-215-2022
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-04-20
• Last Update Date: 2024-01-04

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	207W00000X	Allopathic & Osteopathic Physicians	Ophthalmology		Group - Single Specialty
No	261QA1903X	Ambulatory Health Care Facilities	Clinic/Center	Ambulatory Surgical	Group - Single Specialty
No	332B00000X	Suppliers	Durable Medical Equipment & Medical Supplies
No	332H00000X	Suppliers	Eyewear Supplier

Provider Identifiers

State	Identifier ID	ID Type	Issuer
WA	1019625	Medicaid
WA	0642070005	Medicare NSC
WA	GAB39312	Medicare PIN
WA	G000150300	Medicare PIN
	GAB39312	Medicare ID - Type Unspecified	GROUP
WA	0642070001	Medicare NSC
WA	GAB09665	Medicare PIN
	GAB09665	Medicare ID - Type Unspecified	GROUP
	GAB11045	Medicare ID - Type Unspecified	GROUP
WA	0642070007	Medicare NSC
	G000173400	Medicare ID - Type Unspecified	GROUP
WA	0642070003	Medicare NSC
	GAB08929	Medicare ID - Type Unspecified	GROUP