Provider Demographics
NPI:1144534470
Name:OH, PATRICIA MIESOOK (OD, MS)
Entity type:Individual
Prefix:
First Name:PATRICIA
Middle Name:MIESOOK
Last Name:OH
Suffix:
Gender:F
Credentials:OD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11800 NE 128TH ST STE 300
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98034-7211
Mailing Address - Country:US
Mailing Address - Phone:425-821-8004
Mailing Address - Fax:425-820-9860
Practice Address - Street 1:11800 NE 128TH ST STE 300
Practice Address - Street 2:
Practice Address - City:KIRKLAND
Practice Address - State:WA
Practice Address - Zip Code:98034-7211
Practice Address - Country:US
Practice Address - Phone:425-821-8004
Practice Address - Fax:425-820-9860
Is Sole Proprietor?:No
Enumeration Date:2010-07-28
Last Update Date:2011-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD60149599152W00000X, 152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0280861OtherDEPT OF LABOR & INDUSTRIES
WA1144534470Medicaid
WA8901773Medicare PIN