Basic Information
| Provider Information | |||||||||
| NPI: | 1104253715 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | WHIDBEY EYE CENTER PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 1227 | ||||||||
| Address2: | 109 NE BIRCH ST | ||||||||
| City: | COUPEVILLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982391227 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 109 NE BIRCH ST | ||||||||
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| City: | COUPEVILLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 982391227 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3606782020 | ||||||||
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| ProviderEnumerationDate: | 09/27/2013 | ||||||||
| LastUpdateDate: | 09/27/2013 | ||||||||
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| AuthorizedOfficialLastName: | CICHOWSKI | ||||||||
| AuthorizedOfficialFirstName: | MARK | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3606782020 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Ophthalmology |
No ID Information.