Provider Demographics
NPI:1063105146
Name:DAY, NINA ROSE KENNEY (LDO, ABO ADV, NCLE)
Entity type:Individual
Prefix:
First Name:NINA
Middle Name:ROSE KENNEY
Last Name:DAY
Suffix:
Gender:F
Credentials:LDO, ABO ADV, NCLE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3222 NE 126TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98682-7851
Mailing Address - Country:US
Mailing Address - Phone:360-608-4306
Mailing Address - Fax:360-885-2390
Practice Address - Street 1:221E NE 104TH AVE
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-4599
Practice Address - Country:US
Practice Address - Phone:360-885-1546
Practice Address - Fax:360-885-2390
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-02
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADO00001990156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician