Organization
DAVENPORT VISION CLINIC, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
STACIE R NICHOLS OD (OWNER)
(509) 725-2000
Entity
Organization
Contact information
Practice address
506 8TH ST, DAVENPORT, WA 99122
(509) 725-2000
(509) 725-4231
Mailing address
PO BOX 27, DAVENPORT, WA 99122-0027
(509) 725-2000
(509) 725-4231
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
0D00003248
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2025815
—
WA
01
—
410046744
RAILROAD MEDICARE
WA
Enumeration date
11/15/2006
Last updated
10/15/2009
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