Provider Demographics
NPI:1912943721
Name:GLAUCOMA CONSULTANTS NW P.S.
Entity Type:Organization
Organization Name:GLAUCOMA CONSULTANTS NW P.S.
Other - Org Name:MURRAY A JOHNSTONE MD PS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:PENCE
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-682-3447
Mailing Address - Street 1:1221 MADISON ST
Mailing Address - Street 2:SUITE 1124
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-3588
Mailing Address - Country:US
Mailing Address - Phone:206-682-3447
Mailing Address - Fax:206-682-8219
Practice Address - Street 1:1221 MADISON ST
Practice Address - Street 2:SUITE 1124
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3588
Practice Address - Country:US
Practice Address - Phone:206-682-3447
Practice Address - Fax:206-682-8219
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-21
Last Update Date:2009-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA10295207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7096530Medicaid
WA217137600Medicare ID - Type UnspecifiedMEDICARE GROUP #