Healthcare Provider Details

I. General information

NPI: 1952421372
Provider Name (Legal Business Name): NORTHWEST VISION AND LEARNING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2007
Last Update Date: 01/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 SOUTH 324TH PLACE
FEDERAL WAY WA
98003
US

IV. Provider business mailing address

1705 SOUTH 324TH PLACE
FEDERAL WAY WA
98003
US

V. Phone/Fax

Practice location:
  • Phone: 253-661-6005
  • Fax: 253-661-6005
Mailing address:
  • Phone: 253-661-6005
  • Fax: 253-661-6005

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1583TX
License Number StateWA

VIII. Authorized Official

Name: CURTIS R BAXSTROM
Title or Position: OWNER
Credential: OD
Phone: 253-661-6005