Provider Demographics
NPI:1811445018
Name:NORTHWEST GLAUCOMA AND CATARACT CONSULTANTS, LLC
Entity type:Organization
Organization Name:NORTHWEST GLAUCOMA AND CATARACT CONSULTANTS, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEMBER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:WHITEHEAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-622-2020
Mailing Address - Street 1:1229 MADISON ST
Mailing Address - Street 2:SUITE 1250
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98104-3586
Mailing Address - Country:US
Mailing Address - Phone:206-622-2020
Mailing Address - Fax:206-223-1963
Practice Address - Street 1:1229 MADISON ST
Practice Address - Street 2:SUITE 1250
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98104-3586
Practice Address - Country:US
Practice Address - Phone:206-622-2020
Practice Address - Fax:206-223-1963
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-15
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAASF.FS 60685668261QS0132X, 261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QS0132XAmbulatory Health Care FacilitiesClinic/CenterOphthalmologic Surgery