Provider Demographics
NPI:1528408820
Name:MAHMOUDI, SEMIRAMIS (OD)
Entity Type:Individual
Prefix:DR
First Name:SEMIRAMIS
Middle Name:
Last Name:MAHMOUDI
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 1:22522 SE 14TH PL
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98075-7184
Mailing Address - Country:US
Mailing Address - Phone:425-445-7160
Mailing Address - Fax:
Practice Address - Street 1:22522 SE 14TH PL
Practice Address - Street 2:
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98075-7184
Practice Address - Country:US
Practice Address - Phone:425-445-7160
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-01
Last Update Date:2013-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD60386498152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist