Individual
WILBUR SUSILASATE
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
7101 MARTIN LUTHER KING JR WAY S, #209, SEATTLE, WA 98118-3594
(206) 722-2218
(206) 722-2211
Mailing address
7101 MARTIN LUTHER KING JR WAY S, # 209, SEATTLE, WA 98118-3594
(206) 722-2218
(206) 722-2211
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OD 3608
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2029262
—
WA
05
—
2029528
—
WA
Enumeration date
10/06/2005
Last updated
07/14/2022
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