Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OD60293859 | WA |
NPI | 1013271204 |
---|---|
Provider Name | Christopher G Pellejera |
First Address | Fpo, Ap, GU 96540 |
Second Address | Othello, WA 99344-1040 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/07/2012 |
Last Update Date | 18/01/2018 |