Provider Demographics
NPI:1407804552
Name:WHATCOM VISION CLINICS LLC
Entity Type:Organization
Organization Name:WHATCOM VISION CLINICS LLC
Other - Org Name:OPTOMETRIC PHYSICIANS NW
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:D
Authorized Official - Last Name:BEARDEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:360-676-4030
Mailing Address - Street 1:2222 JAMES ST
Mailing Address - Street 2:STE A
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-4152
Mailing Address - Country:US
Mailing Address - Phone:360-676-4030
Mailing Address - Fax:360-676-8719
Practice Address - Street 1:2222 JAMES ST
Practice Address - Street 2:STE A
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-4152
Practice Address - Country:US
Practice Address - Phone:360-676-4030
Practice Address - Fax:360-676-8719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-04
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00003766152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2019883Medicaid