Provider Demographics
NPI:1295825677
Name:FURUKAWA, JOANNE M (OD)
Entity Type:Individual
Prefix:DR
First Name:JOANNE
Middle Name:M
Last Name:FURUKAWA
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 1:601 S GRADY WAY STE Q
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98055-3229
Mailing Address - Country:US
Mailing Address - Phone:425-227-8888
Mailing Address - Fax:425-227-8428
Practice Address - Street 1:601 S GRADY WAY STE Q
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98057-3229
Practice Address - Country:US
Practice Address - Phone:425-227-8888
Practice Address - Fax:425-227-8428
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001223152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2035905Medicaid
WA2035905Medicaid
WAGAB15674Medicare ID - Type UnspecifiedMEDICARE NUMBER