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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