Individual
MRS. IDAAYU RATIH JENISCH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
OD
Contact information
Practice address
5101 S 283RD PL, AUBURN, WA 98001-1927
(253) 520-2100
Mailing address
5101 S 283RD PL, AUBURN, WA 98001-1927
(253) 520-2100
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OD60195908
WA
Other
Enumeration date
09/19/2009
Last updated
03/03/2011
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