Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OD60582557 | WA |
NPI | 1013393933 |
---|---|
Provider Name | Bryan T Redick |
First Address | Bellingham, WA 98225-6580 |
Second Address | Bellingham, WA 98225-6580 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2015 |
Last Update Date | 14/02/2022 |