Provider Demographics
NPI:1801889480
Name:MERIDIAN OPTICAL INC
Entity type:Organization
Organization Name:MERIDIAN OPTICAL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SEC/TREAS
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:C
Authorized Official - Last Name:YOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-631-4515
Mailing Address - Street 1:24020 132ND AVE SE
Mailing Address - Street 2:SUITE B
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98042-5108
Mailing Address - Country:US
Mailing Address - Phone:253-631-4515
Mailing Address - Fax:253-631-2972
Practice Address - Street 1:24020 132ND AVE SE
Practice Address - Street 2:SUITE B
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98042-5108
Practice Address - Country:US
Practice Address - Phone:253-631-4515
Practice Address - Fax:253-631-2972
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2017440Medicaid