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General NPI Number Information
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NPI Number | 1205297835
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Entity Type | Individual
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Provider Name | VINAYAK VARUN RAVURI O.D.
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Gender | Male
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Dates
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Enumeration Date | 03/09/2016
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Last Update Date | 10/04/2016
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Provider Practice Location Address
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Address Line | 2718 FRANKLIN AVE E APT 11
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City | SEATTLE
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State | WA
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Zip | 98102-3102
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Country | US
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Telephone | 805-216-4744
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Fax |
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Provider Business Mailing Address
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Address Line | 534 BROADWAY E
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City | SEATTLE
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State | WA
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Zip | 98102-5024
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Country | US
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Telephone | 206-325-9740
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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 | 33349
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License Number State | CA
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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 | OD60632311
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License Number State | WA
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