Provider Demographics
NPI:1326454158
Name:ASSAREH, SHAYA (OD)
Entity Type:Individual
Prefix:DR
First Name:SHAYA
Middle Name:
Last Name:ASSAREH
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:PO BOX 5127
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98206-5127
Mailing Address - Country:US
Mailing Address - Phone:425-339-5456
Mailing Address - Fax:
Practice Address - Street 1:3802 COLBY AVE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-4940
Practice Address - Country:US
Practice Address - Phone:425-339-5456
Practice Address - Fax:425-339-5402
Is Sole Proprietor?:No
Enumeration Date:2014-07-01
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD60478752152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2045335Medicaid
WAG8948008Medicare PIN