Individual
JAKE DAVID KENT
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
1815 MAIN ST, FERNDALE, WA 98248-9454
(360) 746-8890
(360) 393-4004
Mailing address
1815 MAIN ST, FERNDALE, WA 98248-9454
(360) 746-8890
(360) 393-4004
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OD60555806
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2049506
—
WA
Enumeration date
09/16/2011
Last updated
12/22/2015
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