Provider Demographics
NPI:1871951731
Name:JORGENSON, DEVI CARSON (LDO)
Entity type:Individual
Prefix:MRS
First Name:DEVI
Middle Name:CARSON
Last Name:JORGENSON
Suffix:
Gender:F
Credentials:LDO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15705 SE 178TH PL
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058
Mailing Address - Country:US
Mailing Address - Phone:206-930-2686
Mailing Address - Fax:
Practice Address - Street 1:401 1ST NE
Practice Address - Street 2:FOR EYEZ & STYLE
Practice Address - City:AUBURN
Practice Address - State:WA
Practice Address - Zip Code:98002-5042
Practice Address - Country:US
Practice Address - Phone:206-930-2686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician