Provider Demographics
NPI:1447464573
Name:NORTHWEST WASHINGTON EYE SPECIALISTS
Entity type:Organization
Organization Name:NORTHWEST WASHINGTON EYE SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:VENEDICT
Authorized Official - Last Name:OSETINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:425-252-2333
Mailing Address - Street 1:1724 WEST MARINE VIEW DRIVE
Mailing Address - Street 2:SUITE 130
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-2088
Mailing Address - Country:US
Mailing Address - Phone:425-252-2333
Mailing Address - Fax:
Practice Address - Street 1:1724 WEST MARINE VIEW DRIVE
Practice Address - Street 2:SUITE 130
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-2088
Practice Address - Country:US
Practice Address - Phone:425-252-2333
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-09
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD000029567207W00000X
WAMD00029567207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina SpecialistGroup - Single Specialty
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty