Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | 00003633 | WA |
NPI | 1366444069 |
---|---|
Provider Name | Ms. Stephanie Kitamura |
First Address | Bellevue, WA 98005-2487 |
Second Address | Bellevue, WA 98005-2487 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/08/2005 |
Last Update Date | 17/01/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
U90810 | (02) | WA |