Provider Demographics
NPI:1942325360
Name:STROMME, JEANETTE MARIE (OD)
Entity Type:Individual
Prefix:MRS
First Name:JEANETTE
Middle Name:MARIE
Last Name:STROMME
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MS
Other - First Name:JEANETTE
Other - Middle Name:M
Other - Last Name:STEARNS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:111 UNIVERSITY PKWY
Mailing Address - Street 2:SUITE 104
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98901-1471
Mailing Address - Country:US
Mailing Address - Phone:509-966-0675
Mailing Address - Fax:509-853-2013
Practice Address - Street 1:111 UNIVERSITY PKWY STE 104
Practice Address - Street 2:
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98901-1448
Practice Address - Country:US
Practice Address - Phone:509-966-0675
Practice Address - Fax:509-853-2013
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2012-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA152W00000X152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2030971Medicaid
WAV05979Medicare UPIN