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General NPI Number Information
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NPI Number | 1902077373
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Entity Type | Organization
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Legal Business Name | STANWOOD EYE CLINIC, INC
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Dates
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Enumeration Date | 03/13/2008
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Last Update Date | 03/13/2008
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Provider Practice Location Address
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Address Line | 27101 PIONEER HWY
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City | STANWOOD
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State | WA
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Zip | 98292
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Country | US
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Telephone | 360-629-9535
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Fax | 360-629-9536
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Provider Business Mailing Address
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Address Line | PO BOX 664
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City | STANWOOD
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State | WA
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Zip | 98292-0664
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Country | US
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Telephone | 360-629-9535
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Fax | 360-629-9536
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. TIMOTHY JOSEPH NIXON
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Credential | O.D.
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Telephone | 360-629-9535
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number | 1505TX
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License Number State | WA
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