Provider Demographics
NPI:1629381405
Name:JAVAHERI, NASIM (OD)
Entity Type:Individual
Prefix:DR
First Name:NASIM
Middle Name:
Last Name:JAVAHERI
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 1:3218 NE 12TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98056-3405
Mailing Address - Country:US
Mailing Address - Phone:425-228-3364
Mailing Address - Fax:425-228-3378
Practice Address - Street 1:3218 NE 12TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98056-3405
Practice Address - Country:US
Practice Address - Phone:425-228-3364
Practice Address - Fax:425-228-3378
Is Sole Proprietor?:No
Enumeration Date:2010-07-21
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD60166211152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist