Provider Demographics
NPI:1669436929
Name:NIKFARJAM, FIROOZEH (OD)
Entity type:Individual
Prefix:DR
First Name:FIROOZEH
Middle Name:
Last Name:NIKFARJAM
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:FIROOZEH
Other - Middle Name:
Other - Last Name:NIKFARJAM
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:2003 132ND ST SE
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98208-7140
Mailing Address - Country:US
Mailing Address - Phone:425-337-3988
Mailing Address - Fax:425-710-0895
Practice Address - Street 1:2003 132ND ST SE
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98208-7140
Practice Address - Country:US
Practice Address - Phone:425-337-3988
Practice Address - Fax:425-710-0895
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-04-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3380152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA3380OtherLICENSE#