Provider Demographics
NPI:1235314964
Name:OUTLOOK VISION, INC
Entity Type:Organization
Organization Name:OUTLOOK VISION, INC
Other - Org Name:SPOKANE VISION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NILS
Authorized Official - Middle Name:W
Authorized Official - Last Name:OHLSEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:509-926-0667
Mailing Address - Street 1:PO BOX 581
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-0581
Mailing Address - Country:US
Mailing Address - Phone:509-926-0667
Mailing Address - Fax:509-922-9849
Practice Address - Street 1:15727 E BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99037
Practice Address - Country:US
Practice Address - Phone:509-926-0667
Practice Address - Fax:509-922-9849
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-31
Last Update Date:2018-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3859152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2023851Medicaid
WA2023851Medicaid