Provider Demographics
NPI:1972630119
Name:HIGHLINE OPTICAL LLC
Entity type:Organization
Organization Name:HIGHLINE OPTICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KIARA
Authorized Official - Middle Name:
Authorized Official - Last Name:DIMOCK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-520-0158
Mailing Address - Street 1:PO BOX 5202
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98064-5202
Mailing Address - Country:US
Mailing Address - Phone:253-520-0158
Mailing Address - Fax:253-854-9860
Practice Address - Street 1:16233 SYLVESTER RD SW STE 240
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3044
Practice Address - Country:US
Practice Address - Phone:206-444-4719
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier