Provider Demographics
NPI:1134315054
Name:BELLINGHAM VISION CLINIC INC
Entity Type:Organization
Organization Name:BELLINGHAM VISION CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:HOVANDER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:360-308-2288
Mailing Address - Street 1:PO BOX 37
Mailing Address - Street 2:
Mailing Address - City:FERNDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98248-0037
Mailing Address - Country:US
Mailing Address - Phone:360-752-2020
Mailing Address - Fax:360-733-9741
Practice Address - Street 1:2001 MAIN ST
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248-9468
Practice Address - Country:US
Practice Address - Phone:360-752-2020
Practice Address - Fax:360-738-9741
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-25
Last Update Date:2009-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOL1488TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2014454Medicaid
WAGAB09865Medicare PIN
WA1326130002Medicare NSC