Provider Demographics
NPI:1831228311
Name:EYE CLINIC OF BREMERTON, INC. P.S.
Entity type:Organization
Organization Name:EYE CLINIC OF BREMERTON, INC. P.S.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:A
Authorized Official - Last Name:KREMER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-307-7917
Mailing Address - Street 1:3260 NW MOUNT VINTAGE WAY
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-6000
Mailing Address - Country:US
Mailing Address - Phone:360-698-9500
Mailing Address - Fax:360-698-9900
Practice Address - Street 1:3260 NW MOUNT VINTAGE WAY
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-6000
Practice Address - Country:US
Practice Address - Phone:360-698-9500
Practice Address - Fax:360-698-9900
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2014-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00031039207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7053721Medicaid
WA45019OtherL&I
WA0794600001Medicare NSC
WAG115153000Medicare ID - Type UnspecifiedGROUP
WACN5843Medicare ID - Type UnspecifiedRAILROAD MEDICARE GROUP