Provider Demographics
NPI:1265485874
Name:DEOL, ANUP (OD)
Entity Type:Individual
Prefix:DR
First Name:ANUP
Middle Name:
Last Name:DEOL
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 1:415 AVENUE D
Mailing Address - Street 2:
Mailing Address - City:SNOHOMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98290-2747
Mailing Address - Country:US
Mailing Address - Phone:360-568-6666
Mailing Address - Fax:360-568-1221
Practice Address - Street 1:415 AVENUE D
Practice Address - Street 2:
Practice Address - City:SNOHOMISH
Practice Address - State:WA
Practice Address - Zip Code:98290-2747
Practice Address - Country:US
Practice Address - Phone:360-568-6666
Practice Address - Fax:360-568-1221
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2010-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2023152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2026128Medicaid
WA2026128Medicaid
WAU38392Medicare UPIN