Provider Demographics
NPI:1720092588
Name:FADHL-POHL, PAULA SUZANNE (OD)
Entity Type:Individual
Prefix:DR
First Name:PAULA
Middle Name:SUZANNE
Last Name:FADHL-POHL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2025 1ST AVE
Mailing Address - Street 2:SUITE C
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98121
Mailing Address - Country:US
Mailing Address - Phone:206-443-0320
Mailing Address - Fax:206-443-0323
Practice Address - Street 1:2025 1ST AVE
Practice Address - Street 2:SUITE C
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98121
Practice Address - Country:US
Practice Address - Phone:206-443-0320
Practice Address - Fax:206-443-0323
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-28
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA00003891TX152W00000X
WA3891TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2031193Medicaid
WAV04230Medicare UPIN