Individual
REBECCA E DOHERTY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LDO
Contact information
Practice address
216 E 5TH ST STE A, PORT ANGELES, WA 98362-3008
(360) 417-1244
(360) 417-1245
Mailing address
PO BOX 774, PORT ANGELES, WA 98362-0134
(360) 417-1244
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
1556
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
WA1410
WA TEAMSTERS
WA
Enumeration date
01/31/2019
Last updated
01/31/2019
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