Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1700X | Ocularist | OS00000017 | WA |
NPI | 1215979836 |
---|---|
Provider Name | Mr. Todd Alan Cranmore |
First Address | Kirkland, WA 98034-3027 |
Second Address | Kirkland, WA 98034-3027 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/06/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
9045758 | (05) | WA |