Provider Demographics
NPI:1689824955
Name:POQUIZ, AMALIA D (OD)
Entity type:Individual
Prefix:DR
First Name:AMALIA
Middle Name:D
Last Name:POQUIZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:AMALIA
Other - Middle Name:
Other - Last Name:POQUIZ MAYOR
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:14050 JUANITA DR NE STE A
Mailing Address - Street 2:SUITE A
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-9708
Mailing Address - Country:US
Mailing Address - Phone:425-820-2020
Mailing Address - Fax:
Practice Address - Street 1:11314 4TH AVE W
Practice Address - Street 2:SUITE 108
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98204-6926
Practice Address - Country:US
Practice Address - Phone:425-353-5544
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-24
Last Update Date:2015-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD60041482152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist