Individual
PAUL NEFEDOV
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
600 TRIANGLE CTR STE 400, LONGVIEW, WA 98632-4667
(360) 423-0220
(360) 423-0697
Mailing address
600 TRIANGLE CTR STE 400, LONGVIEW, WA 98632-4667
(360) 423-0220
(360) 423-0697
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
33688
CA
152W00000X
Optometrist
Primary
ATI4325
OR
152W00000X
Optometrist
OD60997195
WA
Other
Enumeration date
03/31/2016
Last updated
06/17/2022
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