Provider Demographics
NPI:1992880553
Name:NORTHWEST EYE CLINIC INC., P.S.
Entity type:Organization
Organization Name:NORTHWEST EYE CLINIC INC., P.S.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:VINCENT
Authorized Official - Middle Name:ERIBERTO
Authorized Official - Last Name:MATTEUCCI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:360-733-4800
Mailing Address - Street 1:3015 SQUALICUM PKWY
Mailing Address - Street 2:SUITE 260
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1945
Mailing Address - Country:US
Mailing Address - Phone:360-733-4800
Mailing Address - Fax:360-733-2879
Practice Address - Street 1:3015 SQUALICUM PKWY
Practice Address - Street 2:SUITE 270
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1945
Practice Address - Country:US
Practice Address - Phone:360-733-4800
Practice Address - Fax:360-733-2879
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHWEST EYE CLINIC INC PS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-25
Last Update Date:2011-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2019032Medicaid
WA0622710001Medicare NSC
WAG10215Medicare UPIN