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Individual
MR. TAE H BAE
Active
Individual
MR. TAE H BAE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
DO
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
DO 00002034
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DO 00002034
OPTICIAN DISPENSING LICENSE
WA
Enumeration date
12/09/2015
Last updated
12/09/2015
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