Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | 276 | WA |
NPI | 1093944472 |
---|---|
Provider Name | Timothy James Brennan |
First Address | Burien, WA 98166-2307 |
Second Address | Burien, WA 98166-2307 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/07/2009 |
Last Update Date | 07/07/2009 |