Individual
MICHAEL GREGORY FENNO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
102 S OAK ST, COLVILLE, WA 99114-2846
(509) 684-5278
Mailing address
102 S OAK ST, COLVILLE, WA 99114-2846
(509) 684-5278
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1708
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2022960
—
WA
Enumeration date
10/05/2005
Last updated
10/19/2021
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