Provider Demographics
NPI:1114310182
Name:RYAN, KATHERINE MARY (LDO)
Entity Type:Individual
Prefix:
First Name:KATHERINE
Middle Name:MARY
Last Name:RYAN
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:MARY
Other - Last Name:MAY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LDO
Mailing Address - Street 1:351 ORONDO AVE
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-2826
Mailing Address - Country:US
Mailing Address - Phone:509-662-4747
Mailing Address - Fax:509-663-5338
Practice Address - Street 1:351 ORONDO AVE
Practice Address - Street 2:
Practice Address - City:WENATCHEE
Practice Address - State:WA
Practice Address - Zip Code:98801-2826
Practice Address - Country:US
Practice Address - Phone:509-662-4747
Practice Address - Fax:509-663-5338
Is Sole Proprietor?:No
Enumeration Date:2015-03-13
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADO 00000833156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1000288Medicaid