Provider Demographics
NPI:1972683985
Name:OLAVARRIA, MARY (OD)
Entity type:Individual
Prefix:DR
First Name:MARY
Middle Name:
Last Name:OLAVARRIA
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14011 NE WOODINVILLE DUVALL RD
Mailing Address - Street 2:A-6
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-8504
Mailing Address - Country:US
Mailing Address - Phone:425-487-2744
Mailing Address - Fax:
Practice Address - Street 1:14011 NE WOODINVILLE DUVALL RD
Practice Address - Street 2:A-6
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-8504
Practice Address - Country:US
Practice Address - Phone:425-487-2744
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1965152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAOL7854OtherREGENCE
WAOL7854OtherREGENCE
WAU38223Medicare UPIN