Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | DO00001660 | WA |
NPI | 1083715767 |
---|---|
Provider Name | Sharon Zoller |
First Address | Longview, WA 98632-3166 |
Second Address | Longview, WA 98632-3166 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/09/2006 |
Last Update Date | 14/07/2007 |