Provider Demographics
NPI:1447896394
Name:PNW EYE DOCTORS PS
Entity type:Organization
Organization Name:PNW EYE DOCTORS PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:QUANG
Authorized Official - Middle Name:
Authorized Official - Last Name:NGUYEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:503-442-5558
Mailing Address - Street 1:2527 236TH ST SW
Mailing Address - Street 2:
Mailing Address - City:BRIER
Mailing Address - State:WA
Mailing Address - Zip Code:98036-8415
Mailing Address - Country:US
Mailing Address - Phone:503-442-5558
Mailing Address - Fax:
Practice Address - Street 1:11700 MUKILTEO SPEEDWAY STE 501
Practice Address - Street 2:
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-5444
Practice Address - Country:US
Practice Address - Phone:503-442-5558
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty