Provider Demographics
NPI:1053349613
Name:CASCADE FAMILY EYE CARE, PLLC
Entity type:Organization
Organization Name:CASCADE FAMILY EYE CARE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RODERICK
Authorized Official - Middle Name:BLAIR
Authorized Official - Last Name:BEAZER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:801-623-1390
Mailing Address - Street 1:9623 32ND ST SE STE D121
Mailing Address - Street 2:
Mailing Address - City:LAKE STEVENS
Mailing Address - State:WA
Mailing Address - Zip Code:98258-5780
Mailing Address - Country:US
Mailing Address - Phone:425-377-9747
Mailing Address - Fax:425-377-8757
Practice Address - Street 1:9623 32ND ST SE STE D121
Practice Address - Street 2:
Practice Address - City:LAKE STEVENS
Practice Address - State:WA
Practice Address - Zip Code:98258-5780
Practice Address - Country:US
Practice Address - Phone:425-377-9747
Practice Address - Fax:425-377-8757
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-30
Last Update Date:2020-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2085152W00000X
152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1024797OtherMEDICAID DOMAIN #
WA2031821Medicaid