Healthcare Provider Details

I. General information

NPI: 1164365367
Provider Name (Legal Business Name): LAVENDER VISION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/13/2026
Last Update Date: 04/23/2026
Certification Date: 04/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 W WASHINGTON ST
SEQUIM WA
98382-3266
US

IV. Provider business mailing address

955 W WASHINGTON ST
SEQUIM WA
98382-3266
US

V. Phone/Fax

Practice location:
  • Phone: 360-406-2036
  • Fax: 360-406-2037
Mailing address:
  • Phone: 360-406-2036
  • Fax: 360-406-2037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: EMILY KEISTER
Title or Position: DOCTOR/OWNER
Credential: OD
Phone: 360-406-2036