Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OD60096389 | WA |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | OD60096389 | WA |
N | 152WL0500X | Optomitrist - Low Vision Rehabilitation | OD60096389 | WA |
N | 152WP0200X | Pediatric Optomitrist | OD60096389 | WA |
N | 152WX0102X | Occupational Vision | OD60096389 | WA |
NPI | 1184853343 |
---|---|
Provider Name | Brandon Spencer Furness |
First Address | Richland, WA 99352-4390 |
Second Address | Richland, WA 99352-4390 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/07/2009 |
Last Update Date | 29/12/2016 |