Healthcare Provider Details

I. General information

NPI: 1942468905
Provider Name (Legal Business Name): DEEPTA VASUDEV RAWAT M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEEPTA VANI VASUDEV M.D.

II. Dates (important events)

Enumeration Date: 05/27/2008
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 S 320TH ST
FEDERAL WAY WA
98003-5200
US

IV. Provider business mailing address

301 S 320TH ST
FEDERAL WAY WA
98003-5200
US

V. Phone/Fax

Practice location:
  • Phone: 253-874-7000
  • Fax:
Mailing address:
  • Phone: 253-874-7000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberA108827
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD442769
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License NumberMD442769
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberMD60481518
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: