Organization
BONNEY LAKE OPTICAL, INC
Active
Other names
Spanaway Lake Optical
Organization subpart
No
Provider details
NPI number
Authorized official
SEAN CUDAHY (CFO)
(253) 750-8135
Entity
Organization
Contact information
Practice address
9801 204TH AVE E, BONNEY LAKE, WA 98391-6559
(253) 750-8135
Mailing address
9801 204TH AVE E, BONNEY LAKE, WA 98391-6559
(253) 750-8135
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
1640
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2001360
—
WA
Enumeration date
01/04/2007
Last updated
01/31/2023
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