Provider Demographics
NPI:1164854725
Name:OKERSON, ANNE SONG (OD)
Entity Type:Individual
Prefix:DR
First Name:ANNE
Middle Name:SONG
Last Name:OKERSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ANNE
Other - Middle Name:MINNA
Other - Last Name:SONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:505 NE 87TH AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98664-4801
Mailing Address - Country:US
Mailing Address - Phone:360-514-7210
Mailing Address - Fax:
Practice Address - Street 1:505 NE 87TH AVE STE 100
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98664-4801
Practice Address - Country:US
Practice Address - Phone:360-514-7210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-06
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3516AT152W00000X
WAOD60387573152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist