Healthcare Provider Details

I. General information

NPI: 1932524527
Provider Name (Legal Business Name): ROYA HABIBI O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/19/2014
Last Update Date: 11/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 MADISON ST SUITE 600
SEATTLE WA
98104-1306
US

IV. Provider business mailing address

1101 MADISON ST SUITE 600
SEATTLE WA
98104-1306
US

V. Phone/Fax

Practice location:
  • Phone: 206-215-2020
  • Fax: 206-215-2022
Mailing address:
  • Phone: 206-215-2020
  • Fax: 206-215-2022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3565AT
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD60594891
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: