MEDICARE: JASON A SIFRIT & ASSOCIATES

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152WC0802X	Corneal and Contact Management Optometrist

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	11619755	OTHER	WA	CAQH
4	152W00000X	OTHER	WA	HUMANA
5	0317945	OTHER	WA	LABOR & INDUSTRIES
6	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1164011458
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JASON A SIFRIT & ASSOCIATES

Provider Business Mailing Address
First Line	:	2914 E MADISON ST STE 109
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98112-4271
Country	:	US
Telephone Number	:	206-333-0564
Fax Number	:	206-333-0565

Provider Business Practice Location Address
First Line	:	2914 E MADISON ST STE 109
Second Line	:
City	:	SEATTLE
State	:	WA
Zip	:	98112-4271
Country	:	US
Telephone Number	:	206-333-0564
Fax Number	:	206-333-0565

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	JENNIFER LEE MCGUIRE
Credential	:
Telephone Number	:	206-724-7047

Provider Enumeration Date	:	01/12/2021
Last Update Date	:	04/21/2021

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