Provider Demographics
NPI:1306980966
Name:RETINA EYECARE, PLLC
Entity type:Organization
Organization Name:RETINA EYECARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ARPENIK
Authorized Official - Middle Name:
Authorized Official - Last Name:AVAKIAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:425-275-9975
Mailing Address - Street 1:21616 76TH AVE W STE 104
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-7512
Mailing Address - Country:US
Mailing Address - Phone:425-275-9975
Mailing Address - Fax:425-275-9964
Practice Address - Street 1:21616 76TH AVE W STE 104
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-7512
Practice Address - Country:US
Practice Address - Phone:425-275-9975
Practice Address - Fax:425-275-9964
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-16
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7136146Medicaid
WAG99181Medicare UPIN
WA7136146Medicaid