Provider Demographics
NPI:1023349602
Name:KING LASIK INC PS
Entity type:Organization
Organization Name:KING LASIK INC PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:RACHEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:COUWENBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-915-5173
Mailing Address - Street 1:PO BOX 47148
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98146-7148
Mailing Address - Country:US
Mailing Address - Phone:425-525-1000
Mailing Address - Fax:425-525-1001
Practice Address - Street 1:900 SW 16TH ST
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-2631
Practice Address - Country:US
Practice Address - Phone:425-525-1000
Practice Address - Fax:425-525-1001
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-21
Last Update Date:2010-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3260207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty