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General NPI Number Information
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NPI Number | 1902330343
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Entity Type | Organization
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Legal Business Name | AMERICAN HEALTHY VISION CLINIC
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Dates
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Enumeration Date | 04/12/2017
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Last Update Date | 02/08/2021
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Provider Practice Location Address
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Address Line | 762 OUTLET COLLECTION DR SW
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City | AUBURN
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State | WA
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Zip | 98001-6582
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Country | US
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Telephone | 206-412-5830
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Fax | 253-804-1065
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Provider Business Mailing Address
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Address Line | 1019 PIERCE CT NE
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City | RENTON
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State | WA
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Zip | 98056-3536
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Country | US
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Telephone | 206-412-5830
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Fax | 253-804-1065
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | VINH PHUC NGUYEN
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Credential | OD60724663
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Telephone | 206-412-5830
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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 | OD60724663
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License Number State | WA
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