Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | DO00002207 | WA |
NPI | 1235306911 |
---|---|
Provider Name | Amy Roseanne Skucas |
First Address | Yacolt, WA 98675 |
Second Address | Portland, OR 97232 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/05/2008 |
Last Update Date | 08/03/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
DO00002207 | WASHINGTON STATE LICENSED DISPENSING OPTICIAN (01) | WA |