Healthcare Provider Details

I. General information

NPI: 1598639783
Provider Name (Legal Business Name): SIMRIT SANDHU OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2025
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10217 19TH AVE SE STE 102
EVERETT WA
98208-4266
US

IV. Provider business mailing address

10217 19TH AVE SE STE 102
EVERETT WA
98208-4266
US

V. Phone/Fax

Practice location:
  • Phone: 425-316-9400
  • Fax:
Mailing address:
  • Phone: 425-316-9400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number36128
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD.OD.70057292
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: