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General NPI Number Information
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NPI Number | 1053529867
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Entity Type | Organization
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Legal Business Name | LOREN STUECKLE O.D.,P.S.
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Dates
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Enumeration Date | 05/18/2007
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Last Update Date | 01/11/2008
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Provider Practice Location Address
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Address Line | 1321 N COLUMBIA CENTER BLVD SUITE 100
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City | KENNEWICK
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State | WA
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Zip | 99336-2184
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Country | US
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Telephone | 509-783-2555
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Fax | 509-783-0830
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Provider Business Mailing Address
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Address Line | PO BOX 147
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City | YAKIMA
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State | WA
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Zip | 98907-0147
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Country | US
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Telephone | 509-952-4574
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. LOREN G STUECKLE
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Credential | O.D.
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Telephone | 509-952-4574
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 1306
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License Number State | WA
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