Individual
DR. LEIGH GONGAWARE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
1815 MAIN ST, FERNDALE, WA 98248-9454
(360) 746-8890
(360) 393-4004
Mailing address
1815 MAIN ST, FERNDALE, WA 98248-9454
(360) 746-8890
(360) 393-4004
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OD 60481061
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2006335
—
WA
05
—
2087004
—
WA
Enumeration date
10/19/2011
Last updated
10/06/2017
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