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General NPI Number Information
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NPI Number | 1194994350
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Entity Type | Organization
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Legal Business Name | RICHARD S. GREEN
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Dates
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Enumeration Date | 02/21/2008
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Last Update Date | 02/22/2008
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Provider Practice Location Address
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Address Line | 13210 SE 240TH ST STE C2
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City | KENT
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State | WA
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Zip | 98042-5182
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Country | US
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Telephone | 253-631-1530
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Fax | 253-631-5262
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Provider Business Mailing Address
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Address Line | 13210 SE 240TH ST STE C2
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City | KENT
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State | WA
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Zip | 98042-5182
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Country | US
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Telephone | 253-631-1530
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Fax | 253-631-5262
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Authorized Official
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Title or Position | OWNER
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Name | DR. RICHARD S GREEN
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Credential | O.D.
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Telephone | 253-631-1530
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332H00000X
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Taxonomy Name | Eyewear Supplier
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number |
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License Number State |
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