Organization
MAX VISION PLLC
Active
Other names
Eye 5 Optical
Organization subpart
No
Provider details
NPI number
Authorized official
KORY BOTELHO OD (CEO)
(206) 575-4396
Entity
Organization
Contact information
Practice address
411 STRANDER BLVD STE 202, TUKWILA, WA 98188-2959
(206) 575-4396
Mailing address
415 N G ST, TACOMA, WA 98403-2328
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
207W00000X
Ophthalmology Physician
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1407302003
—
WA
Enumeration date
11/17/2020
Last updated
06/22/2022
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