Healthcare Provider Details

I. General information

NPI: 1366816340
Provider Name (Legal Business Name): JINOUS FERDOSIAN OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/13/2015
Last Update Date: 09/20/2021
Certification Date: 09/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17130 AVONDALE WAY NE STE 111
REDMOND WA
98052-4455
US

IV. Provider business mailing address

17130 AVONDALE WAY NE STE 111
REDMOND WA
98052-4455
US

V. Phone/Fax

Practice location:
  • Phone: 425-885-6600
  • Fax: 425-855-6850
Mailing address:
  • Phone: 425-885-6600
  • Fax: 425-855-6850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD70571991
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: