NPI 1366522633

Angelica Rose Sup, OD

Practitioner Optometrist Edmonds, WA

Practice location

Address: 21911 76th Ave W Suite 101, Edmonds, WA 98026-7903
Phone: (425) 774-7723
Fax: (425) 778-2788

Registered specialties

Optometrist Primary

Eye and Vision Services Providers Taxonomy 152W00000X Licence OD00003975 (WA)

Other Optometrist providers in Washington →

Registry record

NPI: 1366522633
Entity type: Individual
Sex (as registered): Female
NPI issued: 17 Oct 2006
Record last updated: 9 Jul 2007

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.