Provider Demographics
NPI:1407580616
Name:FARINELLA, KYARA LEEANNE
Entity Type:Individual
Prefix:
First Name:KYARA
Middle Name:LEEANNE
Last Name:FARINELLA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1705 S 324TH PL
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-8504
Mailing Address - Country:US
Mailing Address - Phone:253-661-6005
Mailing Address - Fax:253-661-0633
Practice Address - Street 1:7400 E ORCHARD RD STE 175-S
Practice Address - Street 2:
Practice Address - City:GREENWOOD VILLAGE
Practice Address - State:CO
Practice Address - Zip Code:80111-2631
Practice Address - Country:US
Practice Address - Phone:303-850-9499
Practice Address - Fax:303-850-7032
Is Sole Proprietor?:No
Enumeration Date:2022-07-13
Last Update Date:2023-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD61320276152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist