Provider Demographics
NPI:1437101490
Name:WASYLYSHYN, KAREN MARIE (OD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:MARIE
Last Name:WASYLYSHYN
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 1:1410 APPLERIDGE ST
Mailing Address - Street 2:
Mailing Address - City:WENATCHEE
Mailing Address - State:WA
Mailing Address - Zip Code:98801-4217
Mailing Address - Country:US
Mailing Address - Phone:509-663-3848
Mailing Address - Fax:
Practice Address - Street 1:131 COTTAGE AVE A
Practice Address - Street 2:
Practice Address - City:CASHMERE
Practice Address - State:WA
Practice Address - Zip Code:98815-1001
Practice Address - Country:US
Practice Address - Phone:509-888-5877
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-17
Last Update Date:2015-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD003091TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2016749Medicaid
WAO53047Medicare UPIN
WA8854803Medicare ID - Type Unspecified