Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1100X | Ophthalmic | DO 00000569 | WA |
N | 156FX1800X | Optician | DO 00000569 | WA |
NPI | 1891175709 |
---|---|
Provider Name | Mr. Jay Ball |
First Address | Yakima, WA 98902-3209 |
Second Address | Yakima, WA 98902 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2015 |
Last Update Date | 05/06/2015 |