Individual
COLE BOBOTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
403 N EUCLID ST, GRANDVIEW, WA 98930-9407
(509) 882-2650
(509) 882-4225
Mailing address
403 N EUCLID ST, GRANDVIEW, WA 98930-9407
(509) 882-2650
(509) 882-4225
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OD60469574
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2021554
—
WA
01
—
91-1936651
VISION SERVICE PLAN
WA
Enumeration date
10/19/2011
Last updated
09/10/2014
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