Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OD60943168 | WA |
NPI | 1003477902 |
---|---|
Provider Name | Dr. Kimber Marie Kenzli |
First Address | University Place, WA 98466-1364 |
Second Address | Federal Way, WA 98003-8504 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/06/2019 |
Last Update Date | 22/06/2019 |