Provider Demographics
NPI:1902608755
Name:BLUE WAVE EYE DOCTORS PROFESSIONAL LIMITED LIABILITY COMPANY
Entity type:Organization
Organization Name:BLUE WAVE EYE DOCTORS PROFESSIONAL LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DOLSIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MCDONALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:726-444-4078
Mailing Address - Street 1:19100 RIDGEWOOD PKWY BUILDING 1
Mailing Address - Street 2:7TH FLOOR
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78259-1834
Mailing Address - Country:US
Mailing Address - Phone:800-340-0129
Mailing Address - Fax:
Practice Address - Street 1:2915 HARRISON AVE NW STE 215
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98502-2593
Practice Address - Country:US
Practice Address - Phone:360-226-1230
Practice Address - Fax:360-810-3549
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-03-25
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier