Provider Demographics
NPI:1972854222
Name:BASHA, FIRAS OMAR (OD)
Entity Type:Individual
Prefix:
First Name:FIRAS
Middle Name:OMAR
Last Name:BASHA
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:11364 SE 82ND AVE
Mailing Address - Street 2:SUITE 402
Mailing Address - City:HAPPY VALLEY
Mailing Address - State:OR
Mailing Address - Zip Code:97086-7637
Mailing Address - Country:US
Mailing Address - Phone:503-305-5084
Mailing Address - Fax:
Practice Address - Street 1:8101 NE PARKWAY DR STE D2&D4
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98662-7911
Practice Address - Country:US
Practice Address - Phone:360-314-6900
Practice Address - Fax:360-433-9180
Is Sole Proprietor?:No
Enumeration Date:2012-09-26
Last Update Date:2019-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3533ATI152W00000X
WAOD60376580152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist