Healthcare Provider Details

I. General information

NPI: 1437101490
Provider Name (Legal Business Name): KAREN MARIE WASYLYSHYN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 09/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 COTTAGE AVE A
CASHMERE WA
98815-1001
US

IV. Provider business mailing address

1410 APPLERIDGE ST
WENATCHEE WA
98801-4217
US

V. Phone/Fax

Practice location:
  • Phone: 509-888-5877
  • Fax:
Mailing address:
  • Phone: 509-663-3848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD003091TX
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: