Organization
WOODLAWN OPTICAL OF BOTHELL,INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. PAUL JOSEPH KAVANAGH LDO (PRESIDENT)
(425) 486-7270
Entity
Organization
Contact information
Practice address
10116 MAIN ST, SUITE 102, BOTHELL, WA 98011-3444
(425) 486-7270
(425) 481-7291
Mailing address
10116 MAIN ST, SUITE 102, BOTHELL, WA 98011-3444
(425) 486-7270
(425) 481-7291
Taxonomy
Speciality
Code
Description
License number
State
332H00000X
Eyewear Supplier
Primary
DO 00001478
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2081206
—
WA
Enumeration date
09/18/2007
Last updated
11/23/2007
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