Healthcare Provider Details

I. General information

NPI: 1093035305
Provider Name (Legal Business Name): MOUNTAIN VIEW EYE CARE CENTER P C
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2010
Last Update Date: 06/27/2024
Certification Date: 06/27/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 SE 164TH AVE STE 102
VANCOUVER WA
98683-9644
US

IV. Provider business mailing address

14415 SE MILL PLAIN BLVD STE. 115-B
VANCOUVER WA
98684-3543
US

V. Phone/Fax

Practice location:
  • Phone: 360-253-4405
  • Fax:
Mailing address:
  • Phone: 360-253-4405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code152WL0500X
TaxonomyLow Vision Rehabilitation Optometrist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. NICHOLAS JANKOWSKI
Title or Position: OWNER
Credential: OD
Phone: 360-253-4405