Provider Demographics
NPI:1538423223
Name:MCGIFFIN, JOHN
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:MCGIFFIN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1824 FRONT ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:LYNDEN
Mailing Address - State:WA
Mailing Address - Zip Code:98264-1729
Mailing Address - Country:US
Mailing Address - Phone:360-933-1815
Mailing Address - Fax:360-933-4617
Practice Address - Street 1:1824 FRONT ST
Practice Address - Street 2:SUITE B
Practice Address - City:LYNDEN
Practice Address - State:WA
Practice Address - Zip Code:98264-1729
Practice Address - Country:US
Practice Address - Phone:360-933-1815
Practice Address - Fax:360-933-4617
Is Sole Proprietor?:No
Enumeration Date:2012-06-27
Last Update Date:2014-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD60291226152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2020069Medicaid
WA2014245Medicaid
WA2006335Medicaid
WA1024566Medicaid
WA2006334Medicaid
WA2020069Medicaid
WA2006334Medicaid
WA2006335Medicaid
WA2014245Medicaid