Individual
MRS. THERESE ANN WORTMAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
L.D.O.
Contact information
Practice address
1230 7TH AVE, LONGVIEW, WA 98632-3166
(360) 636-6238
(360) 636-6231
Mailing address
477 AGREN RD, CASTLE ROCK, WA 98611-9646
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
DO00001755
WA
Other
Enumeration date
08/31/2006
Last updated
07/08/2007
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