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General NPI Number Information
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NPI Number | 1437604964
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Entity Type | Organization
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Legal Business Name | DOUGLAS DUGGAN
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Dates
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Enumeration Date | 08/25/2016
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Last Update Date | 06/27/2019
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Provider Practice Location Address
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Address Line | 2695 E LINCOLN AVE STE C
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City | SUNNYSIDE
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State | WA
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Zip | 98944-4003
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Country | US
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Telephone | 509-836-2818
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Fax | 509-836-2235
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Provider Business Mailing Address
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Address Line | 6022 THYNEWOOD LOOP
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City | WEST RICHLAND
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State | WA
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Zip | 99353-6076
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Country | US
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Telephone | 509-985-6148
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DOUGLAS C DUGGAN
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Credential | OD
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Telephone | 509-836-2818
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OD00003836
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License Number State | WA
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