Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OD00001163 | WA |
NPI | 1003964396 |
---|---|
Provider Name | David E. Harris |
First Address | Seattle, WA 98124-1581 |
Second Address | Everett, WA 98201-3832 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2007 |
Last Update Date | 31/07/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2014074 | (05) | WA |
U21766 | (02) | WA |