Healthcare Provider Details

I. General information

NPI: 1528722394
Provider Name (Legal Business Name): JANAT MATHEW OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/27/2021
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

345 COLLEGE ST SE STE C
OLYMPIA WA
98503-1014
US

IV. Provider business mailing address

345 COLLEGE ST SE STE C
OLYMPIA WA
98503-1014
US

V. Phone/Fax

Practice location:
  • Phone: 360-456-3200
  • Fax: 360-923-4341
Mailing address:
  • Phone: 360-456-3200
  • Fax: 360-923-4341

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD61213356
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: