Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | WA |
NPI | 1083739759 |
---|---|
Provider Name | Lisa Malone |
First Address | Puyallup, WA 98373-3469 |
Second Address | Puyallup, WA 98373-3469 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/03/2007 |
Last Update Date | 08/07/2007 |