Individual
MRS. LISA MARIE KING
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OPTICIAN
Contact information
Practice address
3035 GENESEE ST, CHEEKTOWAGA, NY 14225-2661
(716) 937-4493
(716) 896-0171
Mailing address
3035 GENESEE ST, CHEEKTOWAGA, NY 14225-2661
(716) 937-4493
Taxonomy
Speciality
Code
Description
License number
State
156FX1800X
Optician
Primary
C006185-1
NY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
C006185-1
OPHTHALMIC LICENSE
NY
01
—
NY6185
EYEMED
NY
Enumeration date
02/23/2007
Last updated
07/08/2007
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