Provider Demographics
NPI:1780452078
Name:SCRIVENS, MANDY LEIGH (LDO)
Entity type:Individual
Prefix:
First Name:MANDY
Middle Name:LEIGH
Last Name:SCRIVENS
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1201 SW 13TH AVE
Mailing Address - Street 2:
Mailing Address - City:BATTLE GROUND
Mailing Address - State:WA
Mailing Address - Zip Code:98604-2800
Mailing Address - Country:US
Mailing Address - Phone:360-723-9010
Mailing Address - Fax:360-687-1771
Practice Address - Street 1:1201 SW 13TH AVE
Practice Address - Street 2:
Practice Address - City:BATTLE GROUND
Practice Address - State:WA
Practice Address - Zip Code:98604-2800
Practice Address - Country:US
Practice Address - Phone:360-723-9010
Practice Address - Fax:360-687-1771
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-15
Last Update Date:2024-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA266563156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician