Individual
DR. RUSSELL STEVEN LAKE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
375 HIGHLINE DR, EAST WENATCHEE, WA 98802-5344
(509) 886-0924
Mailing address
375 HIGHLINE DR, EAST WENATCHEE, WA 98802-5344
(509) 886-0924
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
61042825
WA
Other
Enumeration date
06/10/2020
Last updated
06/10/2020
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