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Individual

AMY ROSEANNE SKUCAS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
DO00002207

Contact information

Practice address
500 MULTNOMAH ST, SUITE 100, PORTLAND, OR 97232
(503) 571-5675
Mailing address
PO BOX 213, YACOLT, WA 98675
(360) 903-9717

Taxonomy

Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
DO00002207
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
DO00002207
WASHINGTON STATE LICENSED DISPENSING OPTICIAN
WA
Enumeration date
05/13/2008
Last updated
03/08/2010
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