Provider Demographics
NPI:1255462933
Name:KING, TAMMY LOUISE
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:LOUISE
Last Name:KING
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 1:1960 CLIFF LAKE RD
Mailing Address - Street 2:SUITE 119
Mailing Address - City:EAGAN
Mailing Address - State:MN
Mailing Address - Zip Code:55122-2476
Mailing Address - Country:US
Mailing Address - Phone:651-287-1400
Mailing Address - Fax:651-287-0110
Practice Address - Street 1:1960 CLIFF LAKE RD
Practice Address - Street 2:SUITE 119
Practice Address - City:EAGAN
Practice Address - State:MN
Practice Address - Zip Code:55122-2476
Practice Address - Country:US
Practice Address - Phone:651-287-1400
Practice Address - Fax:651-287-0110
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician