Individual
TIFFANY LUNDBERG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OD
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OD61058089
WA
Other
Enumeration date
06/04/2020
Last updated
06/04/2020
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