Provider Demographics
NPI:1972160976
Name:BIANCARDI, NATHAN JAMES (OD)
Entity Type:Individual
Prefix:
First Name:NATHAN
Middle Name:JAMES
Last Name:BIANCARDI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 W H ST
Mailing Address - Street 2:
Mailing Address - City:DEER PARK
Mailing Address - State:WA
Mailing Address - Zip Code:99006-7167
Mailing Address - Country:US
Mailing Address - Phone:509-276-6932
Mailing Address - Fax:
Practice Address - Street 1:26 W H ST
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:WA
Practice Address - Zip Code:99006-7167
Practice Address - Country:US
Practice Address - Phone:509-276-6932
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-24
Last Update Date:2022-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD60964013152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2135284Medicaid