Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OD00004151 | WA |
NPI | 1013116144 |
---|---|
Provider Name | Seth Bruinsma |
First Address | Kent, WA 98031-4839 |
Second Address | Kent, WA 98031-4839 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/07/2007 |
Last Update Date | 30/05/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0292254 | LABOR & INDUSTRIES (01) | WA |
0992BR | REGENCE (01) | WA |
0993BR | REGENCE (01) | WA |
0994BR | REGENCE (01) | WA |
1091BR | REGENCE (01) | WA |
2016991 | (05) | WA |