Provider Demographics
NPI:1104898014
Name:SIFRIT, JASON ALAN (OD, FAAO)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:ALAN
Last Name:SIFRIT
Suffix:
Gender:M
Credentials:OD, FAAO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:430 BELLEVUE WAY SE APT 106
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004-6660
Mailing Address - Country:US
Mailing Address - Phone:904-504-7121
Mailing Address - Fax:425-776-8481
Practice Address - Street 1:3000 184TH ST SW STE 206
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98037-4769
Practice Address - Country:US
Practice Address - Phone:425-776-8234
Practice Address - Fax:425-776-8481
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-03
Last Update Date:2009-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00004177152W00000X
FLOPC4062152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist