Individual
MCKENZIE SUZANNE FOGARTY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OD
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OD60864286
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2139817
—
WA
Enumeration date
09/13/2018
Last updated
01/03/2024
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