Provider Demographics
NPI:1366816340
Name:FERDOSIAN, JINOUS (OD)
Entity type:Individual
Prefix:DR
First Name:JINOUS
Middle Name:
Last Name:FERDOSIAN
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 1:17130 AVONDALE WAY NE STE 111
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-4455
Mailing Address - Country:US
Mailing Address - Phone:425-885-6600
Mailing Address - Fax:425-855-6850
Practice Address - Street 1:17130 AVONDALE WAY NE STE 111
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-4455
Practice Address - Country:US
Practice Address - Phone:425-885-6600
Practice Address - Fax:425-855-6850
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-13
Last Update Date:2021-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD70571991152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2068399Medicaid