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General NPI Number Information
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NPI Number | 1992872584
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Entity Type | Organization
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Legal Business Name | ISLAND OPTOMETRY CLINIC, INC., P.S.
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Dates
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Enumeration Date | 11/29/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1610 COMMERCIAL AVE
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City | ANACORTES
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State | WA
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Zip | 98221-2275
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Country | US
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Telephone | 360-293-2127
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Fax | 360-293-1354
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Provider Business Mailing Address
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Address Line | 11307 WHISTLE LAKE RD
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City | ANACORTES
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State | WA
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Zip | 98221-4385
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Country | US
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Telephone | 360-293-2127
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Fax | 360-293-1354
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Authorized Official
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Title or Position | OWNER
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Name | DR. MELVIN L FARNSWORTH
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Credential | O.D.
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Telephone | 360-293-2127
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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 | 1542
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License Number State | WA
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