Individual
BIANCA MENDOZA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
601 GOVERNMENT RD, MATTAWA, WA 99349-5120
(509) 488-5256
(509) 488-9939
Mailing address
1515 E COLUMBIA ST, OTHELLO, WA 99344-1846
(509) 488-5250
(509) 488-9939
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OD61335432
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
OD61335432
DOH LICENSE
WA
Enumeration date
08/01/2022
Last updated
08/01/2022
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