Provider Demographics
NPI:1972639417
Name:MARYJANE T HEALEY OD PS
Entity Type:Organization
Organization Name:MARYJANE T HEALEY OD PS
Other - Org Name:MARYJANE T HEALEY OD PS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARYJANE
Authorized Official - Middle Name:T
Authorized Official - Last Name:HEALEY
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:425-882-2020
Mailing Address - Street 1:6710 124TH PL SE
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98296-8649
Mailing Address - Country:US
Mailing Address - Phone:425-338-9426
Mailing Address - Fax:425-338-9426
Practice Address - Street 1:16441 NE 74TH ST
Practice Address - Street 2:E 150
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-7801
Practice Address - Country:US
Practice Address - Phone:425-882-2020
Practice Address - Fax:425-376-2627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2010-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3658152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9634HEOtherREGENCE BLUE SHIELD