Provider Demographics
NPI:1396202016
Name:EMAM, MAHSA MANA (OD)
Entity Type:Individual
Prefix:
First Name:MAHSA
Middle Name:MANA
Last Name:EMAM
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 1:7715 143RD AVE SE
Mailing Address - Street 2:
Mailing Address - City:NEWCASTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98059-3261
Mailing Address - Country:US
Mailing Address - Phone:206-498-9697
Mailing Address - Fax:
Practice Address - Street 1:2448 76TH AVE SE STE 106
Practice Address - Street 2:
Practice Address - City:MERCER ISLAND
Practice Address - State:WA
Practice Address - Zip Code:98040-2782
Practice Address - Country:US
Practice Address - Phone:206-232-1633
Practice Address - Fax:206-232-2502
Is Sole Proprietor?:No
Enumeration Date:2019-02-28
Last Update Date:2023-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60938554152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist