Provider Demographics
NPI:1144537663
Name:HEALEY, MARYJANE THYKKUTTATHIL (OD)
Entity type:Individual
Prefix:DR
First Name:MARYJANE
Middle Name:THYKKUTTATHIL
Last Name:HEALEY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:16441 NE 74TH ST
Mailing Address - Street 2:E-150
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-7801
Mailing Address - Country:US
Mailing Address - Phone:425-882-2020
Mailing Address - Fax:
Practice Address - Street 1:16441 NE 74TH ST
Practice Address - Street 2:E-150
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-7801
Practice Address - Country:US
Practice Address - Phone:425-882-2020
Practice Address - Fax:425-376-2627
Is Sole Proprietor?:No
Enumeration Date:2010-09-03
Last Update Date:2010-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3658 TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist