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General NPI Number Information
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NPI Number | 1801411574
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Entity Type | Individual
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Provider Name | PRABHDEEP SAHOTA
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Gender | Female
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Dates
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Enumeration Date | 06/09/2020
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Last Update Date | 02/05/2025
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Provider Practice Location Address
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Address Line | 32717 1ST AVE S STE 6
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City | FEDERAL WAY
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State | WA
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Zip | 98003-5758
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Country | US
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Telephone | 253-838-5428
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Fax |
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Provider Business Mailing Address
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Address Line | 9801 204TH AVE E
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City | BONNEY LAKE
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State | WA
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Zip | 98391-6559
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Country | US
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Telephone | 253-750-8135
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Fax | 253-750-8136
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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 | 61071405
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License Number State | WA
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