Provider Demographics
NPI:1255505640
Name:SVANDA, KERRI C (OD)
Entity Type:Individual
Prefix:
First Name:KERRI
Middle Name:C
Last Name:SVANDA
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 1:847 NE 102ND ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-7419
Mailing Address - Country:US
Mailing Address - Phone:206-729-3916
Mailing Address - Fax:206-284-8736
Practice Address - Street 1:847 NE 102ND ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125-7419
Practice Address - Country:US
Practice Address - Phone:206-729-3916
Practice Address - Fax:206-284-8736
Is Sole Proprietor?:No
Enumeration Date:2008-04-16
Last Update Date:2008-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3290152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU64002Medicare UPIN