Provider Demographics
NPI:1528281813
Name:FIRST HILL VISION AND BALLARD EYE PHYSICIANS
Entity type:Organization
Organization Name:FIRST HILL VISION AND BALLARD EYE PHYSICIANS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JON
Authorized Official - Middle Name:TYLER
Authorized Official - Last Name:CONNER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:206-783-3828
Mailing Address - Street 1:1801 NW MARKET ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98107-3987
Mailing Address - Country:US
Mailing Address - Phone:206-783-3828
Mailing Address - Fax:206-789-2261
Practice Address - Street 1:1801 NW MARKET ST
Practice Address - Street 2:SUITE 107
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98107-3987
Practice Address - Country:US
Practice Address - Phone:206-783-3828
Practice Address - Fax:206-789-2261
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FIRST HILL VISION AND BALLARD EYE PHYSICIANS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-11
Last Update Date:2014-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2008829Medicaid
WA2008829Medicaid
WAG000109543Medicare ID - Type Unspecified