Provider Demographics
NPI:1538316658
Name:SAFARI VISION LLC
Entity Type:Organization
Organization Name:SAFARI VISION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MERSEDEH
Authorized Official - Middle Name:
Authorized Official - Last Name:SAFARI SNIDER
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:360-253-2781
Mailing Address - Street 1:720 SE 160TH AVE STE #103
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684
Mailing Address - Country:US
Mailing Address - Phone:360-253-2781
Mailing Address - Fax:360-253-2763
Practice Address - Street 1:720 SE 160TH AVE STE 103
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684-8912
Practice Address - Country:US
Practice Address - Phone:360-253-2781
Practice Address - Fax:360-253-2763
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-20
Last Update Date:2008-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA3996261QP2300X
OR3134AT261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care