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General NPI Number Information
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NPI Number | 1427268754
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Entity Type | Organization
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Legal Business Name | LYNDEN VISION CLINIC, PS
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Dates
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Enumeration Date | 05/23/2007
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Last Update Date | 10/02/2012
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Provider Practice Location Address
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Address Line | 201 S 19TH ST
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City | LYNDEN
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State | WA
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Zip | 98264-1725
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Country | US
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Telephone | 360-354-2222
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Fax | 360-354-0737
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Provider Business Mailing Address
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Address Line | 201 S 19TH ST
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City | LYNDEN
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State | WA
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Zip | 98264-1725
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Country | US
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Telephone | 360-354-2222
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Fax | 360-354-0737
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Authorized Official
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Title or Position | OWNER
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Name | DR. MIRA BRIDGET SWIECICKI
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Credential | O.D.
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Telephone | 360-354-2222
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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 | 3271TX
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License Number State | WA
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