Provider Demographics
NPI:1326120825
Name:ITAMURA, VALERIE K (OD)
Entity Type:Individual
Prefix:DR
First Name:VALERIE
Middle Name:K
Last Name:ITAMURA
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 1:2505 SE 125TH AVE
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98683-3828
Mailing Address - Country:US
Mailing Address - Phone:360-896-2923
Mailing Address - Fax:
Practice Address - Street 1:314 E MCLOUGHLIN BLVD
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98663-3387
Practice Address - Country:US
Practice Address - Phone:360-694-8303
Practice Address - Fax:360-694-9032
Is Sole Proprietor?:No
Enumeration Date:2006-10-20
Last Update Date:2013-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00001507152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA024356004OtherREGENCE
WA0199298OtherDEPT. OF LABOR AND IND.
WA2018158Medicaid
WA410016645OtherRR MEDICARE
WA212737OtherEYE MED
WA410016645OtherRR MEDICARE
WAU22146Medicare UPIN