Healthcare Provider Details

I. General information

NPI: 1326591280
Provider Name (Legal Business Name): UMEMA AHMED OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2016
Last Update Date: 07/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22616 BOTHELL EVERETT HWY STE 2
BOTHELL WA
98021-8420
US

IV. Provider business mailing address

4901 NE 25TH ST
RENTON WA
98059-3779
US

V. Phone/Fax

Practice location:
  • Phone: 425-486-8074
  • Fax:
Mailing address:
  • Phone: 425-614-8027
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD 60677353
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: