| NPI | 1043756802 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TRINA WILSON Billing Manager 206-282-8120 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA WA3645) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WA OD4143) |
| 152W00000X Optometrist (Licence: WA WA3729) | |
| 152W00000X Optometrist (Licence: IL 046010818) | |
| Enumeration Date | 2017-01-17 |
| Last Update Date | 2017-04-04 |