| NPI | 1497810071 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | HOLLI JOHNSON Administrator 360-675-2235 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: WA OD00003987) |
| Additional Taxonomies | 152W00000X Optometrist (Licence: WA OD00003150) |
| 152W00000X Optometrist (Licence: WA OD00003901) | |
| Enumeration Date | 2006-12-26 |
| Last Update Date | 2016-04-07 |