Provider Demographics
NPI:1912927468
Name:SEATTLE OPHTHALMIC CONSULTANTS PS
Entity Type:Organization
Organization Name:SEATTLE OPHTHALMIC CONSULTANTS PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:AGNES
Authorized Official - Middle Name:
Authorized Official - Last Name:HUANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-328-7614
Mailing Address - Street 1:600 BROADWAY
Mailing Address - Street 2:STE 100
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-5395
Mailing Address - Country:US
Mailing Address - Phone:206-328-7614
Mailing Address - Fax:206-328-6280
Practice Address - Street 1:600 BROADWAY
Practice Address - Street 2:STE 100
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5395
Practice Address - Country:US
Practice Address - Phone:206-328-7614
Practice Address - Fax:206-328-6280
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-20
Last Update Date:2007-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WADE4332OtherMEDICARE - RAILROAD
WA0210922OtherL&I
WA7133440Medicaid
WAG8858062Medicare PIN