Organization
EVERGREEN EYE CENTER, PLLC
Active
Other names
Evergreen Eye Center, PLLC
Organization subpart
No
Provider details
NPI number
Authorized official
ROSA CAMPOS (CREDENTIALING MANAGER)
(206) 215-2004
Entity
Organization
Contact information
Practice address
700 M ST NE, AUBURN, WA 98002-4586
(800) 340-3595
(855) 929-1515
Mailing address
700 M ST NE, AUBURN, WA 98002-4586
(206) 212-2100
(206) 212-2174
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
—
—
207W00000X
Ophthalmology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0870427
AETNA
WA
05
—
2017242
—
WA
01
—
59460
L&I
WA
05
—
7080781
—
WA
01
—
891451
CRIME VICTIMS
WA
01
—
EV8144
KCM
WA
01
—
P04799
PCMB
WA
01
—
WA0527
NBN AUB
WA
Enumeration date
11/07/2006
Last updated
01/12/2024
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