Provider Demographics
NPI:1164011458
Name:JASON A SIFRIT & ASSOCIATES
Entity Type:Organization
Organization Name:JASON A SIFRIT & ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:MCGUIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:206-724-7047
Mailing Address - Street 1:2914 E MADISON ST STE 109
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98112-4271
Mailing Address - Country:US
Mailing Address - Phone:206-333-0564
Mailing Address - Fax:206-333-0565
Practice Address - Street 1:2914 E MADISON ST STE 109
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98112-4271
Practice Address - Country:US
Practice Address - Phone:206-333-0564
Practice Address - Fax:206-333-0565
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-12
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1060138Medicaid
WA21326723Medicaid
WA11619755OtherCAQH
WA152W00000XOtherHUMANA
WA0317945OtherLABOR & INDUSTRIES
WA1104898014Medicaid