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General NPI Number Information
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NPI Number | 1013570381
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Entity Type | Individual
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Provider Name | ALI MAINAYAR
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Gender | Male
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Dates
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Enumeration Date | 04/22/2019
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Last Update Date | 08/06/2020
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Provider Practice Location Address
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Address Line | 1412 SW 43RD ST # 310
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City | RENTON
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State | WA
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Zip | 98057-4803
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Country | US
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Telephone | 800-826-4631
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Fax |
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Provider Business Mailing Address
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Address Line | 3518 109TH PL NE APT 225
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City | BELLEVUE
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State | WA
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Zip | 98004-7645
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Country | US
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Telephone | 425-830-7252
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | TUV009000-01
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License Number State | NY
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OD61048791
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License Number State | WA
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