Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OD00001906 | WA |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | OD00001906 | WA |
N | 152WP0200X | Pediatric Optomitrist | OD00001906 | WA |
N | 152WV0400X | Optomitrist - Vision Therapist | OD00001906 | WA |
NPI | 1104863356 |
---|---|
Provider Name | Dr. Amy Lynn Riskedahl |
First Address | Tumwater, WA 98512-7355 |
Second Address | Tumwater, WA 98512-7355 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/05/2006 |
Last Update Date | 08/05/2019 |