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General NPI Number Information
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NPI Number | 1194358424
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Entity Type | Individual
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Provider Name | AMY KING LDO
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Gender | Female
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Dates
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Enumeration Date | 02/14/2020
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Last Update Date | 02/14/2020
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Provider Practice Location Address
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Address Line | 111 E NORTH BEND WAY STE A
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City | NORTH BEND
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State | WA
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Zip | 98045-8152
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Country | US
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Telephone | 425-366-9750
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Fax | 425-292-2502
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Provider Business Mailing Address
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Address Line | 249 MAIN AVE. S SUITE 107 PMB 341
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City | NORTH BEND
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State | WA
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Zip | 98045
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Country | US
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Telephone | 425-369-7502
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Fax | 425-292-2502
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 156FX1800X
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Taxonomy Name | Optician
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License Number | DO60973670
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License Number State | WA
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