Organization
FAIRHAVEN VISION CLINIC PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. NANCY IRENE JACOBSEN CPO (OPTICAL TECHNICIAN)
(360) 733-1190
Entity
Organization
Contact information
Practice address
1207 OLD FAIRHAVEN PKWY, BELLINGHAM, WA 98225-7411
(360) 733-1190
(360) 734-1306
Mailing address
1207 OLD FAIRHAVEN PKWY, BELLINGHAM, WA 98225-7411
(360) 733-1190
(360) 734-1306
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OD00000910
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
616790001
GROUP HEALTH
WA
Enumeration date
11/14/2006
Last updated
09/14/2009
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