Individual
GREGORY A WEBSTER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1704 ALLEN ST, KELSO, WA 98626-4907
(360) 577-0606
(360) 636-2986
Mailing address
PO BOX 729, KELSO, WA 98626-0062
(360) 577-0606
(360) 636-2986
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1025
WA
152WC0802X
Corneal and Contact Management Optometrist
1025
WA
152WP0200X
Pediatric Optometrist
1025
WA
152WS0006X
Sports Vision Optometrist
1025
WA
152WX0102X
Occupational Vision Optometrist
1025
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1016328
—
WA
Enumeration date
09/20/2005
Last updated
05/20/2010
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