Healthcare Provider Details

I. General information

NPI: 1467481770
Provider Name (Legal Business Name): STEVEN D KOCH O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2006
Last Update Date: 06/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1190 5TH ST
WENATCHEE WA
98801-1825
US

IV. Provider business mailing address

1190 5TH ST
WENATCHEE WA
98801-1825
US

V. Phone/Fax

Practice location:
  • Phone: 509-662-9671
  • Fax: 509-662-9672
Mailing address:
  • Phone: 509-662-9671
  • Fax: 509-662-9672

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number1494
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: