Provider Demographics
NPI:1053420851
Name:HEDAHL, RAY GEORGE (OD)
Entity type:Individual
Prefix:DR
First Name:RAY
Middle Name:GEORGE
Last Name:HEDAHL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:19220 8TH AVE NE STE A
Mailing Address - Street 2:
Mailing Address - City:POULSBO
Mailing Address - State:WA
Mailing Address - Zip Code:98370-8773
Mailing Address - Country:US
Mailing Address - Phone:360-779-2336
Mailing Address - Fax:360-779-7628
Practice Address - Street 1:19220 8TH AVE NE STE A
Practice Address - Street 2:
Practice Address - City:POULSBO
Practice Address - State:WA
Practice Address - Zip Code:98370-8773
Practice Address - Country:US
Practice Address - Phone:360-779-2336
Practice Address - Fax:360-779-7628
Is Sole Proprietor?:No
Enumeration Date:2006-08-29
Last Update Date:2021-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001086152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2030054Medicaid
WAHE0975OtherREGENCE BLUESHIELD
WA23835OtherPREMERA BLUE CROSS
WA91155102306OtherKPS HEALTH PLANS
WAT02171Medicare UPIN