Provider Demographics
NPI:1386926657
Name:EYE SOCIETY MILL CREEK PLLC
Entity type:Organization
Organization Name:EYE SOCIETY MILL CREEK PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DERIN
Authorized Official - Middle Name:K
Authorized Official - Last Name:TAGUCHI
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:425-232-7164
Mailing Address - Street 1:15407 MAIN ST # E103
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-7375
Mailing Address - Country:US
Mailing Address - Phone:425-357-8234
Mailing Address - Fax:425-357-1333
Practice Address - Street 1:700 110TH AVE NE STE 255
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-5151
Practice Address - Country:US
Practice Address - Phone:425-453-9691
Practice Address - Fax:425-453-9812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-13
Last Update Date:2011-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3686152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty