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General NPI Number Information
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NPI Number | 1255406351
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Entity Type | Organization
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Legal Business Name | HIGHLAND VISION CLINIC, P.S.
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 09/18/2012
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Provider Practice Location Address
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Address Line | 701 N 182ND ST SUITE 101
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City | SHORELINE
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State | WA
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Zip | 98133-4430
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Country | US
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Telephone | 206-542-7406
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Fax | 206-546-2266
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Provider Business Mailing Address
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Address Line | 701 N 182ND ST SUITE 101
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City | SHORELINE
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State | WA
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Zip | 98133-4430
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Country | US
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Telephone | 206-542-7406
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Fax | 206-546-2266
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Authorized Official
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Title or Position | PRESIDENT
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Name | JOHN L OTTO
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Credential | O.D.
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Telephone | 206-542-7406
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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 | OD00001235
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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 | OD00001604
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License Number State | WA
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