Provider Demographics
NPI:1376652198
Name:TONDER, MARIANN JEAN (OD)
Entity Type:Individual
Prefix:DR
First Name:MARIANN
Middle Name:JEAN
Last Name:TONDER
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 1:19220 8TH AVE NE STE A
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-8773
Mailing Address - Country:US
Mailing Address - Phone:360-779-2336
Mailing Address - Fax:360-779-7628
Practice Address - Street 1:19220 8TH AVE NE STE A
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-8773
Practice Address - Country:US
Practice Address - Phone:360-779-2336
Practice Address - Fax:360-779-7628
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2021-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00003052152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2015782Medicaid
WA91155102308OtherKPS HEALTH PLANS
WAT02279OtherREGENCE BLUESHIELD
WA26185OtherPREMERA BLUE CROSS
WAT02279OtherREGENCE BLUESHIELD