Provider Demographics
NPI:1639365984
Name:FARAG, CHRISTINA (OD)
Entity Type:Individual
Prefix:
First Name:CHRISTINA
Middle Name:
Last Name:FARAG
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 1:12301 NE 10TH PL
Mailing Address - Street 2:STE 200
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98005-2487
Mailing Address - Country:US
Mailing Address - Phone:425-450-2020
Mailing Address - Fax:425-688-0620
Practice Address - Street 1:1135 116TH AVE NE STE 450
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-4623
Practice Address - Country:US
Practice Address - Phone:425-450-6990
Practice Address - Fax:425-450-8807
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00003925152W00000X
WA00003925152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8868817Medicare PIN
WADN0066Medicare PIN
WAG8888813Medicare PIN