Provider Demographics
NPI:1871929646
Name:NORTHWEST EYELID AND ORBITAL SPECIALISTS PS
Entity type:Organization
Organization Name:NORTHWEST EYELID AND ORBITAL SPECIALISTS PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:SCOTT
Authorized Official - Last Name:MICHELS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:509-279-2176
Mailing Address - Street 1:626 S. SHERIDAN ST.
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99202-1325
Mailing Address - Country:US
Mailing Address - Phone:509-279-2176
Mailing Address - Fax:509-279-2941
Practice Address - Street 1:626 S SHERIDAN ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99202-1325
Practice Address - Country:US
Practice Address - Phone:509-279-2176
Practice Address - Fax:509-279-2941
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-09-24
Last Update Date:2013-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical