Provider Demographics
NPI:1568636140
Name:AFVC, PLLC
Entity Type:Organization
Organization Name:AFVC, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JUDY
Authorized Official - Middle Name:SMITH
Authorized Official - Last Name:KANDEL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:360-653-8711
Mailing Address - Street 1:16410 SMOKEY POINT BLVD
Mailing Address - Street 2:#101
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-8415
Mailing Address - Country:US
Mailing Address - Phone:360-653-8711
Mailing Address - Fax:
Practice Address - Street 1:16410 SMOKEY POINT BLVD
Practice Address - Street 2:#101
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-8415
Practice Address - Country:US
Practice Address - Phone:360-653-8711
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-15
Last Update Date:2008-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA298442152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA298442OtherAPPID
WA6025083951OtherWA STATE UBI