Provider Demographics
NPI:1598370371
Name:OPTOMETRY MEDICAL GROUP INC
Entity type:Organization
Organization Name:OPTOMETRY MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HUY
Authorized Official - Middle Name:LE
Authorized Official - Last Name:HOANG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:206-395-2285
Mailing Address - Street 1:1721 22ND AVE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98122-3324
Mailing Address - Country:US
Mailing Address - Phone:206-395-2285
Mailing Address - Fax:206-395-2315
Practice Address - Street 1:1721 22ND AVE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-3324
Practice Address - Country:US
Practice Address - Phone:206-395-2285
Practice Address - Fax:206-395-2315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-09
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty