Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | DO00000334 | WA |
NPI | 1013035765 |
---|---|
Provider Name | Mr. Patrick J Ryan |
First Address | Wenatchee, WA 98801-2826 |
Second Address | Wenatchee, WA 98801-2826 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2007 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2008381 | (05) | WA |