Provider Demographics
NPI:1467481770
Name:KOCH, STEVEN D (OD)
Entity Type:Individual
Prefix:DR
First Name:STEVEN
Middle Name:D
Last Name:KOCH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1190 5TH ST
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-1825
Mailing Address - Country:US
Mailing Address - Phone:509-662-9671
Mailing Address - Fax:509-662-9672
Practice Address - Street 1:1190 5TH ST
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-1825
Practice Address - Country:US
Practice Address - Phone:509-662-9671
Practice Address - Fax:509-662-9672
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2008-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1494152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2002236Medicaid
T86898Medicare UPIN
G8858280Medicare PIN