Provider Demographics
NPI:1114070299
Name:KANDEL, JUDY SMITH (OD)
Entity Type:Individual
Prefix:DR
First Name:JUDY
Middle Name:SMITH
Last Name:KANDEL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16410 SMOKEY POINT BLVD
Mailing Address - Street 2:#101
Mailing Address - City:ARLINGTON
Mailing Address - State:WA
Mailing Address - Zip Code:98223-8415
Mailing Address - Country:US
Mailing Address - Phone:360-653-8711
Mailing Address - Fax:
Practice Address - Street 1:16410 SMOKEY POINT BLVD
Practice Address - Street 2:#101
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-8415
Practice Address - Country:US
Practice Address - Phone:360-653-8711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001491152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2088904Medicaid
WA2088904Medicaid
WA8856816Medicare ID - Type Unspecified