Individual
DR. MICHAEL D VAN BROCKLIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
4330 MITCHELL WAY, BELLINGHAM, WA 98226-9175
(360) 738-6860
(360) 738-6853
Mailing address
PO BOX 1506, CHEHALIS, WA 98532-0409
(360) 242-3008
(360) 807-7687
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OD00001307
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
00939832
RAIL ROAD MEDICARE
AK
05
—
1010014
—
WA
05
—
1023190
—
AK
05
—
2027076
—
WA
01
—
410017358
RAIL ROAD MEDICARE
WA
Enumeration date
06/18/2006
Last updated
11/19/2020
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