Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FC0800X | Contact Lens | 1901 | WA |
NPI | 1851479083 |
---|---|
Provider Name | Mrs. Laura Louise Benson |
First Address | Camas, WA 98607-8072 |
Second Address | Camas, WA 98607-8072 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 02/11/2006 |
Last Update Date | 08/07/2007 |