Provider Demographics
NPI:1326136987
Name:KRATTLI, W RICHARD (OD)
Entity Type:Individual
Prefix:
First Name:W
Middle Name:RICHARD
Last Name:KRATTLI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21634 MARINE VIEW DRIVE SOUTH
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:WA
Mailing Address - Zip Code:98198-6154
Mailing Address - Country:US
Mailing Address - Phone:206-878-4233
Mailing Address - Fax:206-878-5818
Practice Address - Street 1:21634 MARINE VIEW DRIVE SOUTH
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:WA
Practice Address - Zip Code:98198-6154
Practice Address - Country:US
Practice Address - Phone:206-878-4233
Practice Address - Fax:206-878-5818
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001598152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA31682OtherLABOR & INDUSTRIES
WA2009017Medicaid
WAKR2035OtherREGENCE BLUE SHIELD
WAKR2035OtherREGENCE BLUE SHIELD