Provider Demographics
NPI:1255419271
Name:BEACH, ALLICIA KIM (OD)
Entity type:Individual
Prefix:MS
First Name:ALLICIA
Middle Name:KIM
Last Name:BEACH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33501 1ST AVE S
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003
Mailing Address - Country:US
Mailing Address - Phone:253-874-1627
Mailing Address - Fax:253-874-1640
Practice Address - Street 1:3500 SOUTH MERIDIAN
Practice Address - Street 2:#345
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98373-3704
Practice Address - Country:US
Practice Address - Phone:253-840-3435
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA4019152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist