| NPI | 1295210011 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | DARREN L THORSEN Member 360-642-3214 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QM2500X Clinic/Center, Medical Specialty |
| Additional Taxonomies | 152W00000X Optometrist |
| 261QS0132X Clinic/Center, Ophthalmologic Surgery | |
| Enumeration Date | 2018-09-27 |
| Last Update Date | 2019-01-11 |