Provider Demographics
NPI:1962793752
Name:UNIVERSITY VISION CLINIC, INC.
Entity type:Organization
Organization Name:UNIVERSITY VISION CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:RAYMOND
Authorized Official - Last Name:HOVANDER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:206-633-2000
Mailing Address - Street 1:4115 UNIVERSITY WAY NE
Mailing Address - Street 2:#101
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-6294
Mailing Address - Country:US
Mailing Address - Phone:206-633-2000
Mailing Address - Fax:206-633-4857
Practice Address - Street 1:4115 UNIVERSITY WAY NE
Practice Address - Street 2:#101
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-6294
Practice Address - Country:US
Practice Address - Phone:206-633-2000
Practice Address - Fax:206-633-4857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1860TX261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center