Provider Demographics
NPI:1295730307
Name:INVERSO, MARLENE J (OD)
Entity type:Individual
Prefix:DR
First Name:MARLENE
Middle Name:J
Last Name:INVERSO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:4336 LIBBY RD NE
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98506-2555
Mailing Address - Country:US
Mailing Address - Phone:360-352-1772
Mailing Address - Fax:360-459-1097
Practice Address - Street 1:406 LILLY RD NE
Practice Address - Street 2:STE A
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98506-5118
Practice Address - Country:US
Practice Address - Phone:360-491-2121
Practice Address - Fax:360-459-1097
Is Sole Proprietor?:No
Enumeration Date:2005-06-15
Last Update Date:2011-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001433152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2015832Medicaid
WA2015832Medicaid
WA001057801Medicare PIN