Vintage Optical LLC

Primary specialty

OpticianTaxonomy code 156FX1800X

Legal business name

VINTAGE OPTICAL LLC

Doing business as

Kitsap Optical

Practice address

3260 NW Mount Vintage Way
Silverdale, WA 98383-6000

Phone

(360) 698-1685

Fax

(360) 698-1763

NPI assigned

Feb 10, 2015

Organization subpart

No

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

Authorized official

Name

Douglas Fairbanks, LDONPI 1316185283

Title

Manager/Member

Phone

(360) 698-1685

Specialties & licenses 1

Addresses

Other names 1

• Kitsap Optical Doing business as

Medicare fee-for-service enrollment

Enrolled in WA

Enrollment records 1

Locations

Practitioners 1

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

• Douglas Fairbanks, L.D.O.

  • Optician
  • Silverdale, WA
  • NPI 1316185283
  NPD Authorized official

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

{
    "created_epoch": "1423526400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1423612800000",
    "number": "1700277803",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3260 NW MOUNT VINTAGE WAY",
            "city": "SILVERDALE",
            "state": "WA",
            "postal_code": "983836000",
            "telephone_number": "360-698-1685",
            "fax_number": "360-698-1763"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3260 NW MOUNT VINTAGE WAY",
            "city": "SILVERDALE",
            "state": "WA",
            "postal_code": "983836000",
            "telephone_number": "360-698-1685",
            "fax_number": "360-698-1763"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "VINTAGE OPTICAL LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-02-10",
        "last_updated": "2015-02-11",
        "status": "A",
        "authorized_official_last_name": "FAIRBANKS",
        "authorized_official_first_name": "DOUGLAS",
        "authorized_official_title_or_position": "MANAGER/MEMBER",
        "authorized_official_telephone_number": "360-698-1685",
        "authorized_official_credential": "LDO"
    },
    "taxonomies": [
        {
            "code": "156FX1800X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Technician/Technologist, Optician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Kitsap Optical",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Nelida Vela
• Robyn B. Vera, DO
• Eleven Vexler, LICSW
• Vikrampsinghllc
• Sierra Sky Vinson, LMP
• Andrew R Visser, MA
• Russell Barnes Voegtlen Jr., MD
• Amanda Vogt, CBD
• Carey Penton Vorholt, LCSW
• Jessica Ann Wadding, MSW, SUDP

• Optician in Silverdale, WA
• Providers in Silverdale, WA by specialty
• Optician in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 2015; 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.