Provider Demographics
NPI:1912259128
Name:BURSETT OPTOMETRY PLLC
Entity type:Organization
Organization Name:BURSETT OPTOMETRY PLLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:SOLE MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:Z
Authorized Official - Last Name:BURSETT
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:206-632-2237
Mailing Address - Street 1:2323 EASTLAKE AVE E, #401
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98102-3305
Mailing Address - Country:US
Mailing Address - Phone:206-632-2237
Mailing Address - Fax:206-632-3811
Practice Address - Street 1:2323 EASTLAKE AVE E, #401
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98102-3305
Practice Address - Country:US
Practice Address - Phone:206-632-2237
Practice Address - Fax:206-632-3811
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-11
Last Update Date:2012-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3337152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty