Individual
DR. KIM P ECKROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
8204 27TH ST W, UNIVERSITY PLACE, WA 98466-2719
(253) 564-9262
(253) 564-0996
Mailing address
8204 27TH ST W, UNIVERSITY PLACE, WA 98466-2719
(253) 564-9262
(253) 564-0996
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OD00003986
WA
152WC0802X
Corneal and Contact Management Optometrist
OD00003986
WA
152WP0200X
Pediatric Optometrist
OD00003986
WA
152WS0006X
Sports Vision Optometrist
OD00003986
WA
152WV0400X
Vision Therapy Optometrist
OD00003986
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2000784
—
WA
Enumeration date
02/02/2006
Last updated
12/04/2007
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