Provider Demographics
NPI:1316166416
Name:MT. BAKER VISION CLINC
Entity type:Organization
Organization Name:MT. BAKER VISION CLINC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DARYS
Authorized Official - Middle Name:
Authorized Official - Last Name:ADAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-733-1720
Mailing Address - Street 1:PO BOX 5566
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98227-5566
Mailing Address - Country:US
Mailing Address - Phone:360-733-1720
Mailing Address - Fax:360-733-0109
Practice Address - Street 1:720 BIRCHWOOD AVE
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1714
Practice Address - Country:US
Practice Address - Phone:360-733-1720
Practice Address - Fax:360-733-0109
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-25
Last Update Date:2010-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2635506Medicaid
WADH0545OtherRAILROAD MEDICARE
WADH0545OtherRAILROAD MEDICARE
WA2635506Medicaid