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General NPI Number Information
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NPI Number | 1952421372
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Entity Type | Organization
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Legal Business Name | NORTHWEST VISION AND LEARNING CENTER
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 01/15/2008
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Provider Practice Location Address
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Address Line | 1705 SOUTH 324TH PLACE
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City | FEDERAL WAY
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State | WA
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Zip | 98003
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Country | US
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Telephone | 253-661-6005
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Fax | 253-661-6005
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Provider Business Mailing Address
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Address Line | 1705 SOUTH 324TH PLACE
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City | FEDERAL WAY
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State | WA
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Zip | 98003
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Country | US
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Telephone | 253-661-6005
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Fax | 253-661-6005
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Authorized Official
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Title or Position | OWNER
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Name | CURTIS R BAXSTROM
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Credential | OD
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Telephone | 253-661-6005
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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 | 1583TX
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License Number State | WA
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