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EVERGREEN EYE ANESTHESIA, PLLC

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Company Details

Legal Name: EVERGREEN EYE ANESTHESIA, PLLC
Jurisdiction: WASHINGTON
Entity Type: WA PROFESSIONAL LIMITED LIABILITY COMPANY
Category: DOMESTIC ENTITY
Status: Active
Formation/ Registration Date: August 12th 2022
Expiration date: 31 Aug 2025
UBI Number: 604 956 875
ZIP code: 98003
City: Federal Way
County: KING
Home State: WASHINGTON
Principal Office Street Address: Google Maps Logo 33600 6TH AVE S STE 200, STE 200, FEDERAL WAY, WA, 98003, UNITED STATES
Principal Office Mailing Address: Google Maps Logo 33600 6TH AVE S STE 200, STE 200, FEDERAL WAY, WA, 98003-6743, UNITED STATES

Contact Details

E-Mail: TDOTLICH@COMP-EYECARE.COM
Phone Number: +1 206-212-2162

Nature of Business

Health Care, Social Assistance & Service Organization

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Registered Agent Information

Name Role
CORPORATION SERVICE COMPANY Registered Agent

Key Officers & Management

Name Role Address
ROBERT TESTER Governing Person -
ROBERT A TESTER MD EXECUTOR 33600 6TH AVE S STE 200, FEDERAL WAY, WA, 98003-6743, UNITED STATES

National Provider Identifier

NPI Number:
1134839319
Certification Date:
2022-12-15

Authorized Person:

Name:
SUZANNE ISOM
Role:
BILLING MANAGER
Phone:

Taxonomy:

Selected Taxonomy:
367500000X - Certified Registered Nurse Anesthetist
Is Primary:
Yes

Contacts:

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