Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | DO00001992 | WA |
NPI | 1235249053 |
---|---|
Provider Name | Mr. Matthew E Suronen |
First Address | Vancouver, WA 98682-4933 |
Second Address | Vancouver, WA 98682-4933 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/08/2006 |
Last Update Date | 17/07/2007 |