| NPI | 1336370964 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHELBY G. WICKHORST Owner, Doctor 360-944-1911 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA OD00003526) |
| Enumeration Date | 2009-07-30 |
| Last Update Date | 2014-09-29 |