Provider Demographics
NPI:1235262890
Name:BARGHOUTI, LENA (OD)
Entity Type:Individual
Prefix:
First Name:LENA
Middle Name:
Last Name:BARGHOUTI
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8700 NE VANCOUVER MALL DR STE 232
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98662-6418
Mailing Address - Country:US
Mailing Address - Phone:360-882-9355
Mailing Address - Fax:360-892-8986
Practice Address - Street 1:8700 NE VANCOUVER MALL DR STE 232
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-6418
Practice Address - Country:US
Practice Address - Phone:360-882-9355
Practice Address - Fax:360-892-8986
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2010-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3034152W00000X
OR2496ATI152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist