Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician |
NPI | 1043376171 |
---|---|
Provider Name | Jeffrey B. Worrell |
First Address | Mount Vernon, WA 98274-4503 |
Second Address | Mount Vernon, WA 98274-4503 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 01/01/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2021368 | (05) | WA |