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General NPI Number Information
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NPI Number | 1417022484
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Entity Type | Organization
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Legal Business Name | DR. WILLIAM BALOGH
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2016 S 320TH ST SUITE E
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City | FEDERAL WAY
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State | WA
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Zip | 98003-5453
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Country | US
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Telephone | 253-839-1610
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Fax | 253-839-0755
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Provider Business Mailing Address
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Address Line | 2016 S 320TH ST SUITE E
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City | FEDERAL WAY
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State | WA
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Zip | 98003-5453
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Country | US
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Telephone | 253-839-1610
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Fax | 253-839-0755
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. MARIA L BURGOS
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Credential |
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Telephone | 253-839-1610
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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 | O.D.00001030
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License Number State | WA
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