Individual
MS. MCKENZIE JOLIE ANN BENNETT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LDO
Contact information
Practice address
700 SLEATER KINNEY RD SE STE E, LACEY, WA 98503-1113
(253) 209-4295
Mailing address
700 SLEATER KINNEY RD SE STE E, LACEY, WA 98503-1113
(253) 209-4295
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
60389139
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
DO60389139
DISPENSING OPTICIANS LICENSE
WA
Enumeration date
02/07/2022
Last updated
03/16/2022
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