Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | DT10004986 | WA |
NPI | 1053427468 |
---|---|
Provider Name | Ms. Cheryl Marie Mcgaw |
First Address | Ridgefield, WA 98642-9541 |
Second Address | Longview, WA 98632-3166 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/08/2006 |
Last Update Date | 08/07/2007 |