Provider Demographics
NPI:1639190150
Name:BOPARAI, HERMINDER S (OD)
Entity type:Individual
Prefix:DR
First Name:HERMINDER
Middle Name:S
Last Name:BOPARAI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:HARRY
Other - Middle Name:S
Other - Last Name:BOPARAI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:1414 116TH AVE NE STE B
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-3801
Mailing Address - Country:US
Mailing Address - Phone:425-502-7922
Mailing Address - Fax:425-502-7975
Practice Address - Street 1:1414 116TH AVE NE STE B
Practice Address - Street 2:
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3801
Practice Address - Country:US
Practice Address - Phone:425-502-7922
Practice Address - Fax:425-502-7975
Is Sole Proprietor?:No
Enumeration Date:2006-07-21
Last Update Date:2024-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD60275254152WC0802X
WAOD60275154152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA02315873Medicaid
NY02315873Medicaid
NY3C6997OtherHEALTH NET
WAU92329Medicare UPIN
NY00815KMedicare PIN
WAC412C1Medicare PIN
WA02315873Medicaid