Provider Demographics
NPI:1770659211
Name:MA, KARIN LEA-ANNE (OD)
Entity Type:Individual
Prefix:DR
First Name:KARIN LEA-ANNE
Middle Name:
Last Name:MA
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 1:13626 33RD DR SE
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-4665
Mailing Address - Country:US
Mailing Address - Phone:917-359-9038
Mailing Address - Fax:
Practice Address - Street 1:305 SE EVERETT MALL WAY STE 21
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-3250
Practice Address - Country:US
Practice Address - Phone:425-386-8428
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2022-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00004099152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist