Provider Demographics
NPI:1629236773
Name:BELLINGHAM FAMILY EYE CLINIC PS
Entity Type:Organization
Organization Name:BELLINGHAM FAMILY EYE CLINIC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GLENN
Authorized Official - Middle Name:D
Authorized Official - Last Name:GREEN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:360-738-2020
Mailing Address - Street 1:450-B BIRCHWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98225-1750
Mailing Address - Country:US
Mailing Address - Phone:360-738-7700
Mailing Address - Fax:360-733-5084
Practice Address - Street 1:450 BIRCHWOOD AVE STE B
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98225-1702
Practice Address - Country:US
Practice Address - Phone:360-738-2020
Practice Address - Fax:360-733-5084
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-27
Last Update Date:2020-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001910332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0513660001Medicare NSC