Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | OD00001555 | WA |
NPI | 1124183264 |
---|---|
Provider Name | David M. Lefevre |
First Address | Dupont, WA 98327-8773 |
Second Address | Dupont, WA 98327-8773 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/12/2006 |
Last Update Date | 27/01/2015 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2063709 | (05) | WA |
T01685 | (02) | WA |