Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OD00001355 | WA |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | OD00001355 | WA |
NPI | 1154371037 |
---|---|
Provider Name | Dr. Claude Kenneth Depew |
First Address | Kennewick, WA 99336-7799 |
Second Address | Kennewick, WA 99336-7799 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 11/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
T02279 | (02) | WA |