Organization
LYNDEN VISION CLINIC, PS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. MIRA BRIDGET SWIECICKI O.D. (OWNER)
(360) 354-2222
Entity
Organization
Contact information
Practice address
201 S 19TH ST, LYNDEN, WA 98264-1725
(360) 354-2222
(360) 354-0737
Mailing address
201 S 19TH ST, LYNDEN, WA 98264-1725
(360) 354-2222
(360) 354-0737
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3271TX
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0078163
LABOR & INDUSTRIES
WA
05
—
2022291
—
WA
01
—
8403LY
REGENCE BLUE SHIELD
WA
01
—
DC7970
RAILROAD MEDICARE-PALMETT
WA
01
—
G8851039
MEDICARE ID-PIN
WA
Enumeration date
05/23/2007
Last updated
10/02/2012
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