# EVERGREEN EYE CENTER, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1104465012
- **Authorized official:** ROSA CAMPOS (CREDENTIALING MANAGER)
- **Authorized official phone:** (206) 215-2004

## Contact information

- **Practice address:** 502 S M ST, TACOMA, WA 98405-3728
- **Practice address phone:** (800) 340-3595
- **Mailing address:** 502 S M ST, TACOMA, WA 98405-3728
- **Mailing address phone:** (206) 260-2503
- **Mailing address fax:** (855) 929-1515

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | — | NULL | Yes |

## Other

- **Enumeration date:** 12/26/2019
- **Last updated:** 01/12/2024