Provider Demographics
NPI:1518651124
Name:SCHNIBBEN, JILLIAN (OD)
Entity type:Individual
Prefix:
First Name:JILLIAN
Middle Name:
Last Name:SCHNIBBEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 35111
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98124-5111
Mailing Address - Country:US
Mailing Address - Phone:425-609-0176
Mailing Address - Fax:206-858-7050
Practice Address - Street 1:2075 BARKLEY BLVD STE 205
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-6614
Practice Address - Country:US
Practice Address - Phone:360-676-6233
Practice Address - Fax:360-676-6298
Is Sole Proprietor?:No
Enumeration Date:2023-06-06
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN18004427A152W00000X
KY2329DT152W00000X
390200000X
WAOD61559662152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program