Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 152W00000X | Optometrist | 3493ATI | OR |
Y | 152W00000X | Optometrist | OD60398390 | WA |
NPI | 1003125188 |
---|---|
Provider Name | Dr. Alex Baldwin |
First Address | White Salmon, WA 98672-1120 |
Second Address | White Salmon, WA 98672-1120 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 06/10/2010 |
Last Update Date | 01/08/2014 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R173977 | (02) | OR |