Organization
SILVERDALE EYE MDS PS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ALEXANDER GLEN RICO M.D. (OWNER)
(360) 337-2015
Entity
Organization
Contact information
Practice address
9399 RIDGETOP BLVD NW, SUITE A, SILVERDALE, WA 98383-9370
(360) 337-2015
Mailing address
9399 RIDGETOP BLVD NW, SUITE A, SILVERDALE, WA 98383-9370
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
MD00026496
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
88113573
—
WA
Enumeration date
12/16/2009
Last updated
02/04/2011
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