Provider Demographics
NPI:1568839231
Name:RUTKOWSKI, IRINA
Entity Type:Individual
Prefix:
First Name:IRINA
Middle Name:
Last Name:RUTKOWSKI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:829 OCEAN BEACH HWY STE 100
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:WA
Mailing Address - Zip Code:98632-4010
Mailing Address - Country:US
Mailing Address - Phone:360-636-2020
Mailing Address - Fax:
Practice Address - Street 1:820 OCEAN BEACH HWY STE 100
Practice Address - Street 2:
Practice Address - City:LONGVIEW
Practice Address - State:WA
Practice Address - Zip Code:98632-4081
Practice Address - Country:US
Practice Address - Phone:360-636-2020
Practice Address - Fax:360-425-0221
Is Sole Proprietor?:No
Enumeration Date:2015-08-28
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61161231152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist