Provider Demographics
NPI:1700193067
Name:HALGRIMSON, KATHERINE A (OD)
Entity Type:Individual
Prefix:MRS
First Name:KATHERINE
Middle Name:A
Last Name:HALGRIMSON
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:KATHERINE
Other - Middle Name:A
Other - Last Name:STOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:SEQUIM VISION CLINIC
Mailing Address - Street 2:541 N 5TH AVE
Mailing Address - City:SEQUIM
Mailing Address - State:WA
Mailing Address - Zip Code:98382
Mailing Address - Country:US
Mailing Address - Phone:360-683-3389
Mailing Address - Fax:360-683-7069
Practice Address - Street 1:SEQUIM VISION CLINIC
Practice Address - Street 2:541 N 5TH AVE
Practice Address - City:SEQUIM
Practice Address - State:WA
Practice Address - Zip Code:98382
Practice Address - Country:US
Practice Address - Phone:360-683-3389
Practice Address - Fax:360-683-7069
Is Sole Proprietor?:No
Enumeration Date:2010-09-08
Last Update Date:2021-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7658T152W00000X
WAOD61076823152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2066900Medicaid