Individual
IAN MATTHEW CHESLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
950 11TH AVE, LONGVIEW, WA 98632-2504
(360) 577-1500
(360) 425-0735
Mailing address
950 11TH AVE, LONGVIEW, WA 98632-2504
(360) 577-1500
(360) 425-0735
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
61169322
WA
Other
Enumeration date
08/05/2021
Last updated
08/05/2021
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