Organization
NORTHSIDE VISION CENTER, P.S.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. CHRIS MICHAEL FAIRBORN O.D. (PRESIDENT)
(509) 326-2772
Entity
Organization
Contact information
Practice address
601 W FRANCIS AVE, SPOKANE, WA 99205-6427
(509) 326-2772
(509) 327-1405
Mailing address
601 W FRANCIS AVE, SPOKANE, WA 99205-6427
(509) 326-2772
(509) 327-1405
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3995TX
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2031219
—
WA
01
—
5493150001
DME#
WA
01
—
DE3597
RAILROAD MEDICARE PIN
WA
Enumeration date
10/15/2006
Last updated
07/15/2022
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