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General NPI Number Information
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NPI Number | 1124199435
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Entity Type | Organization
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Legal Business Name | WHIDBEY VISION CARE INC PS
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Dates
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Enumeration Date | 11/10/2006
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Last Update Date | 04/07/2016
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Provider Practice Location Address
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Address Line | 1690 MAIN ST STE 103
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City | FREELAND
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State | WA
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Zip | 98249
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Country | US
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Telephone | 360-331-8424
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Fax | 360-331-8425
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Provider Business Mailing Address
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Address Line | PO BOX 1048
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City | FREELAND
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State | WA
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Zip | 98249-1048
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Country | US
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Telephone | 360-331-8424
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Fax | 360-331-8425
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | HOLLI JOHNSON
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Credential |
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Telephone | 360-675-2235
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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 | OD00003987
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OD00004139
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License Number State | WA
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OD00003150
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License Number State | WA
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