| NPI | 1104015288 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GREGORY G. BOGDANOVICH Owner 360-532-3611 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA 152W00000XWA1635) |
| Enumeration Date | 2007-10-15 |
| Last Update Date | 2011-05-24 |