| Fairwood Vision Clinic | |
|
14270 Se 176th St Renton WA 98058-8787 | |
| (425) 255-6860 | |
| (425) 255-3262 |
| Full Name | Fairwood Vision Clinic |
|---|---|
| Speciality | Clinic/center |
| Location | 14270 Se 176th St, Renton, Washington |
| Authorized Official Name and Position | Edward M Kosnoski (OWNER) |
| Authorized Official Contact | 2538522020 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Fairwood Vision Clinic Po Box 6609 Kent WA 98064-6609 Ph: (253) 852-2020 | Fairwood Vision Clinic 14270 Se 176th St Renton WA 98058-8787 Ph: (425) 255-6860 |
| NPI Number | 1518047620 |
|---|---|
| Provider Enumeration Date | 10/16/2006 |
| Last Update Date | 08/19/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1518047620 | NPI | - | NPPES |
| DF8532 | Other | WA | RAILROAD MEDICARE GROUP |
| 1012250 | Medicaid | WA |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | (* (Not Available)) | Primary |
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