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General NPI Number Information
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NPI Number | 1093912933
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Entity Type | Organization
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Legal Business Name | MOUNT VERNON VISION SOURCE PS INC
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Dates
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Enumeration Date | 07/02/2007
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Last Update Date | 10/14/2015
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Provider Practice Location Address
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Address Line | 1616 N 18TH ST STE 104
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City | MOUNT VERNON
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State | WA
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Zip | 98273-2600
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Country | US
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Telephone | 360-424-4181
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Fax | 360-424-6414
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Provider Business Mailing Address
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Address Line | 1616 N 18TH ST STE 104
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City | MOUNT VERNON
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State | WA
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Zip | 98273-2600
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Country | US
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Telephone | 360-424-4181
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Fax | 360-424-6414
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Authorized Official
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Title or Position | OWNER
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Name | DR. TOD W JONES
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Credential | O.D.
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Telephone | 360-424-4181
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OD00003502
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License Number State | WA
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