Provider Demographics
NPI:1861436438
Name:PRESTON, KAREN L (OD)
Entity type:Individual
Prefix:
First Name:KAREN
Middle Name:L
Last Name:PRESTON
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 1:14645 BEL RED RD
Mailing Address - Street 2:SUITE E102
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98007-3929
Mailing Address - Country:US
Mailing Address - Phone:425-732-6056
Mailing Address - Fax:425-732-6059
Practice Address - Street 1:14645 BEL RED RD
Practice Address - Street 2:STE E102
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98007-3929
Practice Address - Country:US
Practice Address - Phone:425-732-6056
Practice Address - Fax:425-732-6059
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-15
Last Update Date:2008-02-12
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAOD00001609152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2024370Medicaid
WAU87583Medicare UPIN
WA2024370Medicaid