Provider Demographics
NPI:1629009865
Name:HETTINGER, CHRISTINE (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINE
Middle Name:
Last Name:HETTINGER
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 1:1083 CEDAR AVE
Mailing Address - Street 2:EYE DOCTORS LTD
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-4232
Mailing Address - Country:US
Mailing Address - Phone:360-659-1446
Mailing Address - Fax:360-659-7324
Practice Address - Street 1:8530 EVERGREEN WAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-2614
Practice Address - Country:US
Practice Address - Phone:425-353-2750
Practice Address - Fax:360-659-7324
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-05
Last Update Date:2017-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1366152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2038598Medicaid
WAG8932457Medicare UPIN