Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | OD61048791 | WA |
N | 152W00000X | Optometrist | TUV009000-01 | NY |
NPI | 1013570381 |
---|---|
Provider Name | Ali Mainayar |
First Address | Bellevue, WA 98004-7645 |
Second Address | Renton, WA 98057-4803 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/04/2019 |
Last Update Date | 06/08/2020 |