Organization
PROLIANCE SURGEONS, INC., P.S.
Active
Organization
PROLIANCE SURGEONS, INC., P.S.
Active
Other names
Proliance Retina
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. LAURA KLEISLE (CHIEF RISK OFFICER)
(206) 838-2590
Entity
Organization
Contact information
Practice address
1750 112TH AVE NE STE D050, BELLEVUE, WA 98004
(206) 215-3850
(206) 215-3870
Mailing address
1750 112TH AVE NE STE D050, BELLEVUE, WA 98004-3779
(206) 215-3850
(206) 215-3870
Taxonomy
Speciality
Code
Description
License number
State
207W00000X
Ophthalmology Physician
Primary
601484763
WA
207WX0107X
Retina Specialist (Ophthalmology) Physician
601484763
WA
261QM1300X
Multi-Specialty Clinic/Center
601484763
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2016220
—
WA
01
—
288391
LABOR & INDUSTRIES
WA
Enumeration date
12/05/2011
Last updated
05/28/2021
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