Provider Demographics
NPI:1023082138
Name:RYSENGA, JULIE CATHERINE (MD)
Entity type:Individual
Prefix:
First Name:JULIE
Middle Name:CATHERINE
Last Name:RYSENGA
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1050 SW 3RD AVE
Mailing Address - Street 2:SUITE 2200
Mailing Address - City:ONTARIO
Mailing Address - State:OR
Mailing Address - Zip Code:97914-2193
Mailing Address - Country:US
Mailing Address - Phone:541-881-1300
Mailing Address - Fax:541-889-4321
Practice Address - Street 1:1050 SW 3RD AVE
Practice Address - Street 2:SUITE 2200
Practice Address - City:ONTARIO
Practice Address - State:OR
Practice Address - Zip Code:97914-2193
Practice Address - Country:US
Practice Address - Phone:541-881-1300
Practice Address - Fax:541-889-4321
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR18740207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
IDBBMD2OtherBLUE CROSS OF ID
OR064472Medicaid
IDBBMD2OtherBLUE CROSS OF ID
OR064472Medicaid