Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | OD00001759 | WA |
NPI | 1316057201 |
---|---|
Provider Name | Dr. C. Sanford Berry |
First Address | Olympia, WA 98507-2941 |
Second Address | Tumwater, WA 98512-7363 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U20853 | (02) | WA |