NPI 1104289792 · live from the CMS NPI Registry
Ryan Beck
Optometrist in Kent, WA. National Provider Identifier 1104289792, active.
NPI record
| NPI | 1104289792 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Optometrist 152W00000X |
| Practice location | 19400 108th Ave Se, Kent, WA 98031 |
| Practice phone | 253-852-2120 |
| Mailing address | 6544 Radiance Blvd E, Fife, WA 98424 |
| Enumerated | March 31, 2016 |
| Last updated | March 20, 2018 |
| Sole proprietor | Yes |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | — |
| Optometrist primary | 152W00000X | OD60755918 (WA) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.