Provider Demographics
NPI:1194358424
Name:KING, AMY (LDO)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:249 MAIN AVE. S
Mailing Address - Street 2:SUITE 107 PMB 341
Mailing Address - City:NORTH BEND
Mailing Address - State:WA
Mailing Address - Zip Code:98045
Mailing Address - Country:US
Mailing Address - Phone:425-369-7502
Mailing Address - Fax:425-292-2502
Practice Address - Street 1:111 E NORTH BEND WAY STE A
Practice Address - Street 2:
Practice Address - City:NORTH BEND
Practice Address - State:WA
Practice Address - Zip Code:98045-8152
Practice Address - Country:US
Practice Address - Phone:425-366-9750
Practice Address - Fax:425-292-2502
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-14
Last Update Date:2020-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADO60973670156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician