Provider Demographics
NPI:1093874182
Name:PLASSMANN KING, AUGUSTA ANN (OD)
Entity Type:Individual
Prefix:
First Name:AUGUSTA
Middle Name:ANN
Last Name:PLASSMANN KING
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1521 STACIA ST
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99701-6135
Mailing Address - Country:US
Mailing Address - Phone:907-456-4822
Mailing Address - Fax:
Practice Address - Street 1:1521 STACIA ST
Practice Address - Street 2:UNIT B
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99701-6135
Practice Address - Country:US
Practice Address - Phone:907-456-4822
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-06
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1387152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
COV03983Medicare UPIN
COC801121Medicare ID - Type Unspecified