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General NPI Number Information
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NPI Number | 1326441791
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Entity Type | Organization
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Legal Business Name | LOCK, O.D. PLLC
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Dates
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Enumeration Date | 09/30/2014
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Last Update Date | 09/30/2014
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Provider Practice Location Address
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Address Line | 4735 POINT FOSDICK DR NW SUITE 300
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City | GIG HARBOR
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State | WA
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Zip | 98335-2314
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Country | US
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Telephone | 253-851-4144
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Fax |
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Provider Business Mailing Address
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Address Line | 1303 MONTEREY AVE NE
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City | RENTON
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State | WA
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Zip | 98056-2899
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | LAUREN LOCK
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Credential |
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Telephone | 425-442-8122
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 60473576
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License Number State | WA
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