Provider Demographics
NPI:1396793097
Name:FORREY, JEFFREY ALAN (OD)
Entity type:Individual
Prefix:DR
First Name:JEFFREY
Middle Name:ALAN
Last Name:FORREY
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:16375 NE 85TH ST
Mailing Address - Street 2:SUITE 102
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-3554
Mailing Address - Country:US
Mailing Address - Phone:425-885-7363
Mailing Address - Fax:425-861-5585
Practice Address - Street 1:16375 NE 85TH ST
Practice Address - Street 2:SUITE 102
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-3554
Practice Address - Country:US
Practice Address - Phone:425-885-7363
Practice Address - Fax:425-861-5585
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2007-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA801TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAT01514Medicare UPIN