Provider Demographics
NPI:1952530784
Name:DR. PAULA S. FADHL, LLC
Entity Type:Organization
Organization Name:DR. PAULA S. FADHL, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAULA
Authorized Official - Middle Name:SUZANNE
Authorized Official - Last Name:FADHL-POHL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:206-443-0320
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
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DR. PAULA S FADHL, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-07-14
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3891 TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAV04230Medicare UPIN
V04230Medicare UPIN