Provider Demographics
NPI:1710775630
Name:JINOUS FERDOSIAN LLC
Entity type:Organization
Organization Name:JINOUS FERDOSIAN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JINOUS
Authorized Official - Middle Name:
Authorized Official - Last Name:FERDOSIAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:949-636-3938
Mailing Address - Street 1:11017 111TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:KIRKLAND
Mailing Address - State:WA
Mailing Address - Zip Code:98033-5002
Mailing Address - Country:US
Mailing Address - Phone:949-636-3938
Mailing Address - Fax:949-636-3938
Practice Address - Street 1:1400 164TH ST SW
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98087-8515
Practice Address - Country:US
Practice Address - Phone:425-741-8856
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-04-29
Last Update Date:2025-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1366816340Medicaid