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NPI Code Detail

MEDICARE: KIARA RAE AMUNDSON LDO

MEDICARE: KIARA RAE AMUNDSON LDO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1156FX1800XOpticianDO61575479WA

General Provider Information

NPI Number : 1053130054
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIARA RAE AMUNDSON LDO
Provider Business Mailing Address
First Line : 1110 W WASHINGTON ST
Second Line :
City : SEQUIM
State : WA
Zip : 98382-3270
Country : US
Telephone Number : 360-683-1590
Fax Number : 360-683-7958
Provider Business Practice Location Address
First Line : 1110 W WASHINGTON ST
Second Line :
City : SEQUIM
State : WA
Zip : 98382-3270
Country : US
Telephone Number : 360-683-1590
Fax Number : 360-683-7958
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/07/2024
Last Update Date : 10/07/2024

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Directions to “ KIARA RAE AMUNDSON LDO” Practice Location

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