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General NPI Number Information
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NPI Number | 1184781353
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Entity Type | Organization
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Legal Business Name | VISION HEALTH PS
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 06/20/2024
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Provider Practice Location Address
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Address Line | 5164 CAPITOL BLVD SE
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City | TUMWATER
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State | WA
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Zip | 98501-4442
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Country | US
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Telephone | 360-357-3410
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Fax | 360-357-5652
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Provider Business Mailing Address
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Address Line | 5164 CAPITOL BLVD SE
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City | TUMWATER
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State | WA
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Zip | 98501-4442
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Country | US
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Telephone | 360-357-3410
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Fax | 360-357-5652
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. RICHARD WHITNEY BAXTER
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Credential | OD
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Telephone | 360-357-3410
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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 | 1530 TX
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License Number State | WA
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