| NPI | 1598993131 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JODI SUTTON Billing Administrator 360-861-8257 |
| Organization Subpart ? | No |
| Primary Taxonomy | 152W00000X Optometrist (Licence: OR 2823ATI) |
| Additional Taxonomies | 261Q00000X Clinic/Center (Licence: OR 2823ATI) |
| Enumeration Date | 2009-06-22 |
| Last Update Date | 2009-09-25 |