Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 3073TX | WA |
N | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 3073TX | WA |
NPI | 1114096146 |
---|---|
Provider Name | Dr. Patrick Gerard Squires |
First Address | Bellingham, WA 98228-1317 |
Second Address | Bellingham, WA 98225-0951 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/11/2006 |
Last Update Date | 30/10/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
130706 | LABOR AND INDUSTRIES (01) | WA |
2015972 | (05) | WA |
74309 | REGENCE BLUE SHIELD (01) | WA |
GAB16225 | MEDICARE GROUP # (01) | WA |
U47515 | (02) | WA |