1194895169 NPI number — MRS. MERSEDEH SAFARI SNIDER O.D.

Table of content: MRS. MERSEDEH SAFARI SNIDER O.D. (NPI 1194895169)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1194895169 NPI number — MRS. MERSEDEH SAFARI SNIDER O.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SAFARI SNIDER
Provider First Name:
MERSEDEH
Provider Middle Name:
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
O.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
SAFARI
Provider Other First Name:
MERSEDEH
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
O.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1194895169
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/20/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
720 SE 160TH AVE STE 103
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
VANCOUVER
Provider Business Mailing Address State Name:
WA
Provider Business Mailing Address Postal Code:
98684-8912
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
360-253-2781
Provider Business Mailing Address Fax Number:
360-253-2763

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
720 SE 160TH AVE
Provider Second Line Business Practice Location Address:
STE 103
Provider Business Practice Location Address City Name:
VANCOUVER
Provider Business Practice Location Address State Name:
WA
Provider Business Practice Location Address Postal Code:
98684
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
360-816-4411
Provider Business Practice Location Address Fax Number:
360-836-5373
Provider Enumeration Date:
11/08/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  3134AT , registered in the state of OR ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 152W00000X , with the licence number: 3996 , registered in the state of WA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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