Provider Demographics
NPI:1821165911
Name:EYE PHYSICIANS OF OLYMPIA INC PS
Entity type:Organization
Organization Name:EYE PHYSICIANS OF OLYMPIA INC PS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GRANT
Authorized Official - Middle Name:
Authorized Official - Last Name:AAKER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-456-3200
Mailing Address - Street 1:345 COLLEGE ST SE STE C
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-1014
Mailing Address - Country:US
Mailing Address - Phone:360-456-3200
Mailing Address - Fax:360-456-3894
Practice Address - Street 1:345 COLLEGE ST SE STE C
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-1014
Practice Address - Country:US
Practice Address - Phone:360-456-3200
Practice Address - Fax:360-456-3894
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-30
Last Update Date:2024-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA7858806Medicaid
WA7107766Medicaid
WAGAB22228Medicare PIN
WA7107766Medicaid