Provider Demographics
NPI:1699267146
Name:BELLEVUE EYE MEDICAL CENTER, INC.
Entity type:Organization
Organization Name:BELLEVUE EYE MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING COORDINATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ERICKSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-679-3363
Mailing Address - Street 1:1936 UNIVERSITY AVE STE 112
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-1003
Mailing Address - Country:US
Mailing Address - Phone:510-488-6767
Mailing Address - Fax:510-488-6766
Practice Address - Street 1:1936 UNIVERSITY AVE STE 112
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-1003
Practice Address - Country:US
Practice Address - Phone:510-488-6767
Practice Address - Fax:510-488-6766
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-05-31
Last Update Date:2020-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA87857207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1699267146Medicaid