Provider Demographics
NPI:1235464850
Name:KHY OPTOMETRY & ASSOCIATES, PLLC
Entity Type:Organization
Organization Name:KHY OPTOMETRY & ASSOCIATES, PLLC
Other - Org Name:LACEY EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEREN
Authorized Official - Middle Name:H
Authorized Official - Last Name:YANG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:360-456-2008
Mailing Address - Street 1:6812 DESPERADO DR SE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98501-6106
Mailing Address - Country:US
Mailing Address - Phone:360-350-0174
Mailing Address - Fax:360-413-1675
Practice Address - Street 1:1350 MARVIN RD NE STE D
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516-3877
Practice Address - Country:US
Practice Address - Phone:360-456-2008
Practice Address - Fax:360-413-1675
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-15
Last Update Date:2009-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00003898261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2034361Medicaid