Provider Demographics
NPI:1821472499
Name:BALANI, NATASHA K (OD)
Entity Type:Individual
Prefix:DR
First Name:NATASHA
Middle Name:K
Last Name:BALANI
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 1:3025 112TH AVE NE STE 200
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-8002
Mailing Address - Country:US
Mailing Address - Phone:425-451-2020
Mailing Address - Fax:425-450-9696
Practice Address - Street 1:3025 112TH AVE NE STE 200
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-8002
Practice Address - Country:US
Practice Address - Phone:425-451-2020
Practice Address - Fax:425-450-9696
Is Sole Proprietor?:No
Enumeration Date:2015-07-14
Last Update Date:2023-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60570700152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2023067Medicaid
WA2023067Medicaid
WAGAB40225Medicare PIN