Provider Demographics
NPI:1346241544
Name:IVERSEN, DENISE MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:DENISE
Middle Name:MARIE
Last Name:IVERSEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:DENISE
Other - Middle Name:MARIE
Other - Last Name:CLOSE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:10990 HARBOR HILL DR NW
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98332-8945
Mailing Address - Country:US
Mailing Address - Phone:253-853-8613
Mailing Address - Fax:253-853-8614
Practice Address - Street 1:10990 HARBOR HILL DR NW
Practice Address - Street 2:
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98332-8945
Practice Address - Country:US
Practice Address - Phone:253-853-8613
Practice Address - Fax:253-853-8614
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2013-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD3967152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8871458OtherMEDICARE WA
WA2033769Medicaid
WA2033769Medicaid