EVERGREEN EYE CENTER PLLC NPI 1821167479

NPI Information

NPI: 1821167479
Provider Name: EVERGREEN EYE CENTER, PLLC

Doing Business As: EVERGREEN EYE SURGERY CENTER

Classification: Clinic/Center - 261QA1903X
Entity Type: Organization

Specialization: Ambulatory Surgical

Address:
34719 6TH AVE S
FEDERAL WAY, WA
ZIP 98003
Phone: (206) 212-2100
Get Directions

EVERGREEN EYE CENTER, PLLC is an ambulatory surgical clinic center in Federal Way, WA. EVERGREEN EYE CENTER, PLLC NPI is 1821167479. The provider is registered as an organization entity type.
The provider Is Doing Business As Evergreen Eye Surgery Center.

The provider's business location address is:

34719 6TH AVE S
FEDERAL WAY, WA
ZIP 98003-714
Phone: (206) 212-2100
Fax: (206) 212-2174

The provider's authorized official is Rosa Angelica Campos .
The authorized official title is Credentialing Manager and has the following contact phone number (206) 215-2004.

The CLIA number assigned to this NPI record is 50D0926546 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 11/7/2006 and was last updated on 1/12/2024.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QA1903X	Clinic/Center	Ambulatory Surgical			Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	490003159	OTHER	WASHINGTON	RAILROAD MEDICARE ASC NUM
2	7081250	MEDICAID	WASHINGTON
3	EV5682	OTHER	WASHINGTON	REGENCE ASC NUMBER
4	P06705	OTHER	WASHINGTON	PCMB ASC NUMBER
5	111881	OTHER	WASHINGTON	L&I ASC NUMBER
6	NBN	OTHER	WASHINGTON	WA0527

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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