Individual
STACEY KEPPOL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
2606 116TH AVE NE STE 100, BELLEVUE, WA 98004-1422
(425) 462-7664
Mailing address
PO BOX 1506, CHEHALIS, WA 98532-0409
(360) 242-3010
(206) 858-7050
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OD60840014
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
12564332
CAQH PROVIDER NUMBER
PA
05
—
2096921
—
WA
Enumeration date
07/03/2013
Last updated
03/07/2024
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