Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 156FX1700X | Ocularist | OR |
NPI | 1689199317 |
---|---|
Provider Name | Christina King |
First Address | Portland, OR 97210-2864 |
Second Address | Portland, OR 97210-2864 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 03/08/2017 |
Last Update Date | 25/10/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
01621900001 | REGENCE (01) | OR |
500647964 | OMAP (01) | OR |
7760590001 | MEDICARE (01) | OR |