Healthcare Provider Details

I. General information

NPI: 1730827445
Provider Name (Legal Business Name): CHARANPREET SAMRA OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/23/2022
Last Update Date: 07/26/2026
Certification Date: 07/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7330 164TH AVE NE STE E150
REDMOND WA
98052-7852
US

IV. Provider business mailing address

PO BOX 68412
SEATAC WA
98168-0412
US

V. Phone/Fax

Practice location:
  • Phone: 425-869-2337
  • Fax: 844-333-0296
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number61312777
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: