Provider Demographics
NPI:1699947200
Name:NORTHWEST EYE & SKIN SURGEONS INC PS
Entity type:Organization
Organization Name:NORTHWEST EYE & SKIN SURGEONS INC PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AGNIESZKA
Authorized Official - Middle Name:J
Authorized Official - Last Name:NIEMEYER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-681-6900
Mailing Address - Street 1:558 N 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-3201
Mailing Address - Country:US
Mailing Address - Phone:360-681-6900
Mailing Address - Fax:360-681-6222
Practice Address - Street 1:558 N 5TH AVE
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3201
Practice Address - Country:US
Practice Address - Phone:360-681-6900
Practice Address - Fax:360-681-6222
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-24
Last Update Date:2023-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00048475207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
00A733660Medicare PIN
H99313Medicare UPIN