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General NPI Number Information
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NPI Number | 1225971807
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Entity Type | Individual
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Provider Name | ROSA YANELY BUSTAMANTE REYES OPTI.DO.70120069
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Gender | Female
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Dates
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Enumeration Date | 04/10/2026
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Last Update Date | 04/10/2026
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Provider Practice Location Address
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Address Line | 7017 NE HIGHWAY 99 STE 202
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City | VANCOUVER
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State | WA
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Zip | 98665-0553
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Country | US
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Telephone | 360-694-0760
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Fax | 360-694-1091
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Provider Business Mailing Address
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Address Line | 807 NE 163RD AVE APT B
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City | VANCOUVER
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State | WA
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Zip | 98684-9669
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Country | US
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Telephone | 360-771-7885
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | OPTI.DO.70120069
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License Number State | WA
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