| NPI | 1356413439 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | NANCY IRENE JACOBSEN Optical Technician 360-733-1190 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA OD00000910) |
| Enumeration Date | 2006-11-14 |
| Last Update Date | 2009-09-14 |