Provider Demographics
NPI:1124459193
Name:SEA FAMILY EYE CARE, PLLC
Entity type:Organization
Organization Name:SEA FAMILY EYE CARE, PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER, OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:SAVATEI
Authorized Official - Middle Name:SUSAN
Authorized Official - Last Name:SEA
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:206-940-0723
Mailing Address - Street 1:2448 76TH AVE SE STE 106
Mailing Address - Street 2:
Mailing Address - City:MERCER ISLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98040-2782
Mailing Address - Country:US
Mailing Address - Phone:206-232-1633
Mailing Address - Fax:206-232-2502
Practice Address - Street 1:2448 76TH AVE SE STE 106
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-2782
Practice Address - Country:US
Practice Address - Phone:206-232-1633
Practice Address - Fax:206-232-2502
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-02
Last Update Date:2013-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2010382Medicaid
WA1922313345Medicare UPIN