Healthcare Provider Details

I. General information

NPI: 1043339252
Provider Name (Legal Business Name): FARIBA DANESHGARAN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 10/16/2024
Certification Date: 10/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 LAKE BELLEVUE DR STE 208
BELLEVUE WA
98005-2454
US

IV. Provider business mailing address

9 LAKE BELLEVUE DR STE 208
BELLEVUE WA
98005-2454
US

V. Phone/Fax

Practice location:
  • Phone: 425-777-1089
  • Fax: 425-285-8029
Mailing address:
  • Phone: 425-777-1089
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number11815
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3523
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: