Provider Demographics
NPI:1053130054
Name:AMUNDSON, KIARA RAE (LDO)
Entity type:Individual
Prefix:
First Name:KIARA
Middle Name:RAE
Last Name:AMUNDSON
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382-3270
Mailing Address - Country:US
Mailing Address - Phone:360-683-1590
Mailing Address - Fax:360-683-7958
Practice Address - Street 1:1110 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382-3270
Practice Address - Country:US
Practice Address - Phone:360-683-1590
Practice Address - Fax:360-683-7958
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADO61575479156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician