Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 3140 | WA |
NPI | 1194745729 |
---|---|
Provider Name | Dr. Dana Anthony Cocke |
First Address | Tacoma, WA 98409-7120 |
Second Address | Tacoma, WA 98409-7120 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2006 |
Last Update Date | 24/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2019289 | (05) | WA |
U55473 | (02) | WA |