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General NPI Number Information
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NPI Number | 1295730307
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Entity Type | Individual
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Provider Name | MARLENE J. INVERSO O.D.
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Gender | Female
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Dates
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Enumeration Date | 06/15/2005
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Last Update Date | 02/07/2011
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Provider Practice Location Address
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Address Line | 406 LILLY RD NE STE A
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City | OLYMPIA
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State | WA
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Zip | 98506-5118
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Country | US
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Telephone | 360-491-2121
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Fax | 360-459-1097
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Provider Business Mailing Address
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Address Line | 4336 LIBBY RD NE
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City | OLYMPIA
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State | WA
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Zip | 98506-2555
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Country | US
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Telephone | 360-352-1772
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Fax | 360-459-1097
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OD00001433
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License Number State | WA
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