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General NPI Number Information
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NPI Number | 1235314964
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Entity Type | Organization
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Legal Business Name | OUTLOOK VISION, INC
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Dates
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Enumeration Date | 12/31/2007
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Last Update Date | 06/18/2018
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Provider Practice Location Address
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Address Line | 15727 E BROADWAY AVE
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City | SPOKANE VALLEY
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State | WA
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Zip | 99037
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Country | US
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Telephone | 509-926-0667
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Fax | 509-922-9849
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Provider Business Mailing Address
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Address Line | PO BOX 581
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City | LIBERTY LAKE
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State | WA
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Zip | 99019-0581
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Country | US
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Telephone | 509-926-0667
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Fax | 509-922-9849
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. NILS W. OHLSEN
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Credential | O.D.
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Telephone | 509-926-0667
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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 | 3859
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License Number State | WA
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