Provider Demographics
NPI:1134258783
Name:PICARD, JOHN EUGENE (OD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:EUGENE
Last Name:PICARD
Suffix:
Gender:M
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:PO BOX 3376
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-3376
Mailing Address - Country:US
Mailing Address - Phone:360-692-3300
Mailing Address - Fax:
Practice Address - Street 1:10000 MICKLEBERRY RD
Practice Address - Street 2:COSTCO
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383
Practice Address - Country:US
Practice Address - Phone:360-308-2132
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-02
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1720TX152W00000X
OR152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAT68015Medicare UPIN