Organization
VINTAGE OPTICAL LLC
Active
Other names
Kitsap Optical
Organization subpart
No
Provider details
NPI number
Authorized official
DOUGLAS FAIRBANKS LDO (MANAGER/MEMBER)
(360) 698-1685
Entity
Organization
Contact information
Practice address
3260 NW MOUNT VINTAGE WAY, SILVERDALE, WA 98383-6000
(360) 698-1685
(360) 698-1763
Mailing address
3260 NW MOUNT VINTAGE WAY, SILVERDALE, WA 98383-6000
(360) 698-1685
(360) 698-1763
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
—
—
Other
Enumeration date
02/10/2015
Last updated
02/11/2015
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