Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1800X | Optician | DO60973670 | WA |
NPI | 1194358424 |
---|---|
Provider Name | Amy King |
First Address | North Bend, WA 98045 |
Second Address | North Bend, WA 98045-8152 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2020 |
Last Update Date | 14/02/2020 |