# VINTAGE OPTICAL LLC

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- **Entity:** Organization
- **Status:** Active
- **Other names:** Kitsap Optical
- **Organization subpart:** No

## Provider details

- **NPI number:** 1700277803
- **Authorized official:** DOUGLAS FAIRBANKS LDO (MANAGER/MEMBER)
- **Authorized official phone:** (360) 698-1685

## Contact information

- **Practice address:** 3260 NW MOUNT VINTAGE WAY, SILVERDALE, WA 98383-6000
- **Practice address phone:** (360) 698-1685
- **Practice address fax:** (360) 698-1763
- **Mailing address:** 3260 NW MOUNT VINTAGE WAY, SILVERDALE, WA 98383-6000
- **Mailing address phone:** (360) 698-1685
- **Mailing address fax:** (360) 698-1763

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 156FX1800X | Optician | — | NULL | Yes |
| 156FX1800X | Optician | — | — | Yes |

## Other

- **Enumeration date:** 02/10/2015
- **Last updated:** 02/11/2015