Provider Demographics
NPI:1295934362
Name:KOVAL, IRENE (OD)
Entity type:Individual
Prefix:DR
First Name:IRENE
Middle Name:
Last Name:KOVAL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16528 CLEVELAND ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-4460
Mailing Address - Country:US
Mailing Address - Phone:425-885-1974
Mailing Address - Fax:425-882-7818
Practice Address - Street 1:16528 CLEVELAND ST
Practice Address - Street 2:SUITE 1
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-4460
Practice Address - Country:US
Practice Address - Phone:425-885-1974
Practice Address - Fax:425-882-7818
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-17
Last Update Date:2012-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00004157152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist