# EVERGREEN EYE CENTER, PLLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Evergreen Eye Surgery Center
- **Organization subpart:** No

## Provider details

- **NPI number:** 1821167479
- **Authorized official:** ROSA ANGELICA CAMPOS (CREDENTIALING MANAGER)
- **Authorized official phone:** (206) 215-2004

## Contact information

- **Practice address:** 34719 6TH AVE S, FEDERAL WAY, WA 98003-8714
- **Practice address phone:** (206) 212-2100
- **Practice address fax:** (206) 212-2174
- **Mailing address:** 34719 6TH AVE S, FEDERAL WAY, WA 98003-8714
- **Mailing address phone:** (206) 212-2100
- **Mailing address fax:** (206) 212-2171

## Taxonomy

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

## Other

- **Enumeration date:** 11/07/2006
- **Last updated:** 01/12/2024

## Other identifiers

| Code | Description | Identifier | Issuer | State |
| --- | --- | --- | --- | --- |
| 01 | — | 111881 | L&I ASC NUMBER | WA |
| 01 | — | 490003159 | RAILROAD MEDICARE ASC NUM | WA |
| 05 | — | 7081250 | — | WA |
| 01 | — | EV5682 | REGENCE ASC NUMBER | WA |
| 01 | — | NBN | WA0527 | WA |
| 01 | — | P06705 | PCMB ASC NUMBER | WA |