Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OD00000891 | WA |
NPI | 1003918988 |
---|---|
Provider Name | Dr. James Henry Weyrich |
First Address | Montesano, WA 98563 |
Second Address | Aberdeen, WA 98520 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/09/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2961704 | (05) | WA |