Provider Demographics
NPI:1194895169
Name:SAFARI SNIDER, MERSEDEH (OD)
Entity type:Individual
Prefix:MRS
First Name:MERSEDEH
Middle Name:
Last Name:SAFARI SNIDER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MERSEDEH
Other - Middle Name:
Other - Last Name:SAFARI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:720 SE 160TH AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98684-8912
Mailing Address - Country:US
Mailing Address - Phone:360-253-2781
Mailing Address - Fax:360-253-2763
Practice Address - Street 1:720 SE 160TH AVE
Practice Address - Street 2:STE 103
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98684
Practice Address - Country:US
Practice Address - Phone:360-816-4411
Practice Address - Fax:360-836-5373
Is Sole Proprietor?:No
Enumeration Date:2006-11-08
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3134AT152W00000X
WA3996152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist