Healthcare Provider Details

I. General information

NPI: 1639190150
Provider Name (Legal Business Name): HERMINDER S BOPARAI O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: HARRY S BOPARAI O.D.

II. Dates (important events)

Enumeration Date: 07/21/2006
Last Update Date: 12/05/2024
Certification Date: 12/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1414 116TH AVE NE STE B
BELLEVUE WA
98004-3801
US

IV. Provider business mailing address

1414 116TH AVE NE STE B
BELLEVUE WA
98004-3801
US

V. Phone/Fax

Practice location:
  • Phone: 425-502-7922
  • Fax: 425-502-7975
Mailing address:
  • Phone: 425-502-7922
  • Fax: 425-502-7975

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOD60275254
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD60275154
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: