Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | OD00001440 | WA |
NPI | 1164531471 |
---|---|
Provider Name | Dr. Charles David Mead |
First Address | Ridgefield, WA 98642-8913 |
Second Address | Vancouver, WA 98686-1448 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 08/07/2007 |