Provider Demographics
NPI:1285722405
Name:MASTERS, DONALD K (LDO)
Entity type:Individual
Prefix:
First Name:DONALD
Middle Name:K
Last Name:MASTERS
Suffix:
Gender:M
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10120 163RD AVE NE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3015
Mailing Address - Country:US
Mailing Address - Phone:425-881-1834
Mailing Address - Fax:
Practice Address - Street 1:12911 120TH AVE NE
Practice Address - Street 2:C-80
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-3027
Practice Address - Country:US
Practice Address - Phone:425-821-1820
Practice Address - Fax:425-823-4218
Is Sole Proprietor?:No
Enumeration Date:2006-10-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA458156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2108405Medicaid
WA2108405Medicaid