Organization
EVERGREEN EYE CENTER, PLLC
Active
Other names
Evergreen Eye Center
Organization subpart
No
Provider details
NPI number
Authorized official
ROSA ANGELICA CAMPOS (CREDENTIALING MANAGER)
(206) 215-2004
Entity
Organization
Contact information
Practice address
2820 GRIFFIN AVE STE 101, ENUMCLAW, WA 98022-2373
(360) 802-4549
(360) 825-8354
Mailing address
34719 6TH AVE S, FEDERAL WAY, WA 98003-8714
(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
—
7080781
—
WA
01
—
891451
CRIME VICS ENUMCLAW EEC
WA
01
—
EV8144
KCM
WA
01
—
WA0527
NBN
WA
Enumeration date
11/07/2006
Last updated
01/12/2024
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