Fairhaven Vision Clinic PLLC

Primary specialty

OptometristTaxonomy code 152W00000X

License

OD00000910 Issued in WA

Legal business name

FAIRHAVEN VISION CLINIC PLLC

Practice address

1207 Old Fairhaven Pkwy
Bellingham, WA 98225-7411

Phone

(360) 733-1190

Fax

(360) 734-1306

NPI assigned

Nov 14, 2006

Last updated

Sep 14, 2009By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Nancy Irene Jacobsen, CPO

Title

Optical Technician

Phone

(360) 733-1190

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Locations

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Andrew Lee Barber, OD

  • Optometrist
  • Bellingham, WA
  • NPI 1588735377
  Medicare reassignment Care Compare group NPD
• James William Santoro, O.D.

  • Optometrist
  • Federal Way, WA
  • NPI 1578799292
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1163462400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1252886400000",
    "number": "1356413439",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1207 OLD FAIRHAVEN PKWY",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "982257411",
            "telephone_number": "360-733-1190",
            "fax_number": "360-734-1306"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1207 OLD FAIRHAVEN PKWY",
            "city": "BELLINGHAM",
            "state": "WA",
            "postal_code": "982257411",
            "telephone_number": "360-733-1190",
            "fax_number": "360-734-1306"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAIRHAVEN VISION CLINIC PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-14",
        "last_updated": "2009-09-14",
        "status": "A",
        "authorized_official_last_name": "JACOBSEN",
        "authorized_official_first_name": "NANCY",
        "authorized_official_middle_name": "IRENE",
        "authorized_official_title_or_position": "OPTICAL TECHNICIAN",
        "authorized_official_telephone_number": "360-733-1190",
        "authorized_official_name_prefix": "Ms.",
        "authorized_official_credential": "CPO"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD00000910",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "GROUP HEALTH",
            "identifier": "616790001",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Fairhaven Behavioral Health & Wellness PC
• Fairhaven Dermatology, PLLC
• Fairhaven Integrative Health, PLLC (Fairhaven Integrative Health)
• Fairhaven Lactation, LLC
• Fairhaven Medical Center
• Faith Alliance LLC (BrightStar Care Bellingham/Mount Vernon)
• Emily Falls, BCBA, LBA, MED
• Family Care Network PLLC (Family Care Network Medical Testing Center)
• Family Care Network PLLC (Foster Medical Center)
• Family Care Network PLLC (Family Health Associates)

• Optometrist in Bellingham, WA
• Providers in Bellingham, WA by specialty
• Optometrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2009; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.