Provider Demographics
NPI:1699700294
Name:SAMMAMISH VISION CENTER
Entity type:Organization
Organization Name:SAMMAMISH VISION CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:RISKEDAHL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:425-391-1116
Mailing Address - Street 1:3310 E LAKE SAMMAMISH PKWY SE
Mailing Address - Street 2:SUITE E
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98075-7497
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3310 E LAKE SAMMAMISH PKWY SE
Practice Address - Street 2:SUITE E
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98075-7497
Practice Address - Country:US
Practice Address - Phone:425-391-1116
Practice Address - Fax:425-391-0460
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA217128700Medicare ID - Type Unspecified