Provider Demographics
NPI:1275225302
Name:CERVANTES, KARISA M (OD)
Entity Type:Individual
Prefix:
First Name:KARISA
Middle Name:M
Last Name:CERVANTES
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KARISA
Other - Middle Name:M
Other - Last Name:MERRILL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:443 SW EVERGREEN AVE
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:OR
Mailing Address - Zip Code:97756-2817
Mailing Address - Country:US
Mailing Address - Phone:541-923-2221
Mailing Address - Fax:541-923-3776
Practice Address - Street 1:443 SW EVERGREEN AVE
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:OR
Practice Address - Zip Code:97756-2817
Practice Address - Country:US
Practice Address - Phone:541-923-2221
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-25
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAT4715152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist