Healthcare Provider Details

I. General information

NPI: 1831294503
Provider Name (Legal Business Name): CAROLINE KAUFMAN O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CAROLINE NIBLER O.D.

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 02/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4317 FACTORIA BLVD SE SUITE A
BELLEVUE WA
98006-1937
US

IV. Provider business mailing address

4317 FACTORIA BLVD SE SUITE A
BELLEVUE WA
98006-1937
US

V. Phone/Fax

Practice location:
  • Phone: 425-641-2020
  • Fax: 425-641-7899
Mailing address:
  • Phone: 425-641-2020
  • Fax: 425-641-7899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberOD3162TX
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: