Provider Demographics
NPI:1386416121
Name:THAYER, VENA MARIE (DO60444151)
Entity type:Individual
Prefix:
First Name:VENA
Middle Name:MARIE
Last Name:THAYER
Suffix:
Gender:F
Credentials:DO60444151
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:714 W KIERNAN AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-2985
Mailing Address - Country:US
Mailing Address - Phone:509-638-3182
Mailing Address - Fax:
Practice Address - Street 1:2301 W WELLESLEY AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-5004
Practice Address - Country:US
Practice Address - Phone:509-327-0444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-25
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOpticianGroup - Single Specialty