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General NPI Number Information
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NPI Number | 1235464850
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Entity Type | Organization
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Legal Business Name | KHY OPTOMETRY & ASSOCIATES, PLLC
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Dates
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Enumeration Date | 10/15/2009
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Last Update Date | 12/10/2009
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Provider Practice Location Address
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Address Line | 1350 MARVIN RD NE STE D
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City | LACEY
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State | WA
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Zip | 98516-3877
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Country | US
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Telephone | 360-456-2008
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Fax | 360-413-1675
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Provider Business Mailing Address
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Address Line | 6812 DESPERADO DR SE
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City | OLYMPIA
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State | WA
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Zip | 98501-6106
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Country | US
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Telephone | 360-350-0174
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Fax | 360-413-1675
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Authorized Official
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Title or Position | OWNER
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Name | DR. KEREN H. YANG
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Credential | OD
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Telephone | 360-456-2008
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | OD00003898
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License Number State | WA
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