Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 61003166 | WA |
NPI | 1003337593 |
---|---|
Provider Name | Courtney Rafferty |
First Address | Lake Stevens, WA 98258-3798 |
Second Address | Everett, WA 98207-1098 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/07/2017 |
Last Update Date | 08/12/2019 |