Provider Demographics
NPI:1366273138
Name:OPTISPAN
Entity type:Organization
Organization Name:OPTISPAN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR, CHIEF MEDICAL OFF
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:HADDAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:206-499-3819
Mailing Address - Street 1:12201 TUKWILA INTERNATIONAL BLVD STE 209
Mailing Address - Street 2:
Mailing Address - City:TUKWILA
Mailing Address - State:WA
Mailing Address - Zip Code:98168-5121
Mailing Address - Country:US
Mailing Address - Phone:206-718-9531
Mailing Address - Fax:877-839-6528
Practice Address - Street 1:12101 TUKWILA INTERNATIONAL BLVD STE 203
Practice Address - Street 2:
Practice Address - City:TUKWILA
Practice Address - State:WA
Practice Address - Zip Code:98168-2569
Practice Address - Country:US
Practice Address - Phone:206-718-9531
Practice Address - Fax:877-839-6528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service