Provider Demographics
NPI:1861050833
Name:JONES, KAYLIE MARIE
Entity type:Individual
Prefix:
First Name:KAYLIE
Middle Name:MARIE
Last Name:JONES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:822 N 10TH PL STE A
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98057-5593
Mailing Address - Country:US
Mailing Address - Phone:425-276-5752
Mailing Address - Fax:425-207-8829
Practice Address - Street 1:822 N 10TH PL STE A
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-5593
Practice Address - Country:US
Practice Address - Phone:425-276-5752
Practice Address - Fax:425-207-8829
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-04
Last Update Date:2019-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADO60961368156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician