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General NPI Number Information
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NPI Number | 1417135567
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Entity Type | Organization
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Legal Business Name | KING AND MOCKOVAK EYE CENTER, INC., P.S.
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Dates
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Enumeration Date | 01/31/2008
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Last Update Date | 06/24/2008
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Provider Practice Location Address
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Address Line | 900 SW 16TH ST SUITE 200
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City | RENTON
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State | WA
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Zip | 98057-2631
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Country | US
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Telephone | 425-525-2202
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Fax |
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Provider Business Mailing Address
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Address Line | 900 SW 16TH ST SUITE 200
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City | RENTON
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State | WA
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Zip | 98057-2631
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Country | US
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Telephone | 425-525-2202
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Fax |
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Authorized Official
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Title or Position | CFO
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Name | CHRISTIAN MONEA
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Credential |
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Telephone | 425-525-2202
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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 | 4048
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License Number State | WA
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