Provider Demographics
NPI:1538345699
Name:STOLP, JEANINE N (OD)
Entity type:Individual
Prefix:
First Name:JEANINE
Middle Name:N
Last Name:STOLP
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:JEANINE
Other - Middle Name:N
Other - Last Name:MORASCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:9671 N NEVADA ST STE 210
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1146
Mailing Address - Country:US
Mailing Address - Phone:509-468-2020
Mailing Address - Fax:509-468-3272
Practice Address - Street 1:9671 N NEVADA ST STE 210
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1146
Practice Address - Country:US
Practice Address - Phone:509-468-2020
Practice Address - Fax:509-468-3272
Is Sole Proprietor?:No
Enumeration Date:2008-01-18
Last Update Date:2018-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD60028246152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist