Provider Demographics
NPI:1356902209
Name:MOLODYH, MASHA L (OD)
Entity type:Individual
Prefix:DR
First Name:MASHA
Middle Name:L
Last Name:MOLODYH
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MASHA
Other - Middle Name:
Other - Last Name:CHEUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:307 MONITOR RD
Mailing Address - Street 2:
Mailing Address - City:SILVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97381-1212
Mailing Address - Country:US
Mailing Address - Phone:503-910-5528
Mailing Address - Fax:
Practice Address - Street 1:30020 SW BOONES FERRY RD STE 10
Practice Address - Street 2:
Practice Address - City:WILSONVILLE
Practice Address - State:OR
Practice Address - Zip Code:97070-8912
Practice Address - Country:US
Practice Address - Phone:503-570-0963
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-21
Last Update Date:2019-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR4445ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist