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General NPI Number Information
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NPI Number | 1619225190
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Entity Type | Individual
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Provider Name | SHANI ELIZA RERECICH O.D.
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Gender | Female
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Dates
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Enumeration Date | 08/15/2012
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Last Update Date | 07/30/2014
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Provider Practice Location Address
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Address Line | 1600 E. JEFFERSON ST STE #202
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City | SEATTLE
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State | WA
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Zip | 98122-1737
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Country | US
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Telephone | 425-320-2630
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Fax |
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Provider Business Mailing Address
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Address Line | 5021 RIPLEY LANE N #302
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City | RENTON
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State | WA
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Zip | 98056-1576
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Country | US
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Telephone | 425-273-4368
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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 | OD60291669
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License Number State | WA
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