Lynden Vision Clinic, PS

Primary specialty

OptometristTaxonomy code 152W00000X

License

3271TX Issued in WA

Legal business name

LYNDEN VISION CLINIC, PS

Practice address

201 S 19TH St
Lynden, WA 98264-1725

Phone

(360) 354-2222

Fax

(360) 354-0737

NPI assigned

May 23, 2007

Organization subpart

No

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

Authorized official

Name

Dr. Mira Bridget Swiecicki, O.D.NPI 1689639023

Title

Owner

Phone

(360) 354-2222

Specialties & licenses 1

Addresses

Other identifiers 5

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Other NPIs on the same Medicare enrollment 1

NPIs listed together on one Medicare enrollment, typically parts of the same organization.

• Lynden Vision Clinic, PS

  • Optometrist
  • Bellingham, WA
  • NPI 1780921304

  O20050202000711

  Same enrollment

Locations

Subparts reporting this organization as parent 1

Organizations that report themselves as subparts in NPPES and name this organization, in the same state, as their parent.

• Lynden Vision Clinic, PS

  • Optometrist
  • Bellingham, WA
  • NPI 1780921304
  NPPES parent name

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Mira B Swiecicki, O.D.

  • Optometrist
  • Lynden, WA
  • NPI 1689639023
  Medicare reassignment Authorized official

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

{
    "created_epoch": "1179878400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1349136000000",
    "number": "1427268754",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "201 S 19TH ST",
            "city": "LYNDEN",
            "state": "WA",
            "postal_code": "982641725",
            "telephone_number": "360-354-2222",
            "fax_number": "360-354-0737"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "201 S 19TH ST",
            "city": "LYNDEN",
            "state": "WA",
            "postal_code": "982641725",
            "telephone_number": "360-354-2222",
            "fax_number": "360-354-0737"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "LYNDEN VISION CLINIC, PS",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-05-23",
        "last_updated": "2012-10-02",
        "status": "A",
        "authorized_official_last_name": "SWIECICKI",
        "authorized_official_first_name": "MIRA",
        "authorized_official_middle_name": "BRIDGET",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "360-354-2222",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "WA",
            "license": "3271TX",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2022291",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE ID-PIN",
            "identifier": "G8851039",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LABOR & INDUSTRIES",
            "identifier": "0078163",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "REGENCE BLUE SHIELD",
            "identifier": "8403LY",
            "state": "WA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAILROAD MEDICARE-PALMETT",
            "identifier": "DC7970",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Lynden Family Physical Therapy PS Inc.
• Lynden Medical X-Ray LLC
• Lynden School District
• Lynden School District 504
• Lynden Therapy Specialists, Inc.
• Scott William Lyon, DPT
• Allie Macomber, FNLP
• Marian F Maden
• Katherine Mahoney, ARNP
• Helen J Martin, CD(DONA)

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 2012; 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.