Individual
MIRANDA HUENERS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
61116371
WA
152W00000X
Optometrist
Primary
OD61116371
WA
152W00000X
Optometrist
OPT-002436
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
300117730
—
WA
01
—
OD61116371
STATE LICENSE
WA
Enumeration date
07/08/2020
Last updated
08/03/2021
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