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General NPI Number Information
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NPI Number | 1134315054
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Entity Type | Organization
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Legal Business Name | BELLINGHAM VISION CLINIC INC
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Dates
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Enumeration Date | 09/25/2007
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Last Update Date | 09/10/2009
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Provider Practice Location Address
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Address Line | 2001 MAIN ST
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City | FERNDALE
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State | WA
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Zip | 98248-9468
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Country | US
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Telephone | 360-752-2020
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Fax | 360-738-9741
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Provider Business Mailing Address
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Address Line | PO BOX 37
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City | FERNDALE
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State | WA
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Zip | 98248-0037
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Country | US
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Telephone | 360-752-2020
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Fax | 360-733-9741
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Authorized Official
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Title or Position | OWNER
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Name | DR. MICHAEL STEVEN HOVANDER
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Credential | O.D.
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Telephone | 360-308-2288
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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 | OL1488TX
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License Number State | WA
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