Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 1153TX | WA |
NPI | 1003932856 |
---|---|
Provider Name | Alma John Carter |
First Address | Kennewick, WA 99336-8120 |
Second Address | Kennewick, WA 99336-8120 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/03/2007 |
Last Update Date | 08/07/2007 |