1700193067 NPI number — MRS. KATHERINE A HALGRIMSON OD

Table of content: MRS. KATHERINE A HALGRIMSON OD (NPI 1700193067)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1700193067 NPI number — MRS. KATHERINE A HALGRIMSON OD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HALGRIMSON
Provider First Name:
KATHERINE
Provider Middle Name:
A
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
OD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
STOLA
Provider Other First Name:
KATHERINE
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
OD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1700193067
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/22/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
SEQUIM VISION CLINIC
Provider Second Line Business Mailing Address:
541 N 5TH AVE
Provider Business Mailing Address City Name:
SEQUIM
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98382
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-683-3389
Provider Business Mailing Address Fax Number:
360-683-7069

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
SEQUIM VISION CLINIC
Provider Second Line Business Practice Location Address:
541 N 5TH AVE
Provider Business Practice Location Address City Name:
SEQUIM
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98382
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-683-3389
Provider Business Practice Location Address Fax Number:
360-683-7069
Provider Enumeration Date:
09/08/2010

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  7658T , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 152W00000X , with the licence number: OD61076823 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2066900 , issued by the state of ( WA ) . This identifiers is of the category "MEDICAID".




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