Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | CERTEFIED | OR |
NPI | 1225147218 |
---|---|
Provider Name | Bradley A Tate |
First Address | Portland, OR 97236-7858 |
Second Address | Vancouver, WA 98686-1448 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 08/07/2007 |