Provider Demographics
NPI:1366907321
Name:SABET, SEPIDEH POURPIRALI (OD)
Entity type:Individual
Prefix:
First Name:SEPIDEH
Middle Name:POURPIRALI
Last Name:SABET
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:SEPIDEH
Other - Middle Name:POURPIRALI
Other - Last Name:RISHEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SEPIDEH POURPIRALI
Mailing Address - Street 1:3820 DEL BONITA WAY
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-8858
Mailing Address - Country:US
Mailing Address - Phone:360-296-1283
Mailing Address - Fax:
Practice Address - Street 1:1815 MAIN ST STE 101
Practice Address - Street 2:
Practice Address - City:FERNDALE
Practice Address - State:WA
Practice Address - Zip Code:98248-9454
Practice Address - Country:US
Practice Address - Phone:360-746-8890
Practice Address - Fax:360-393-4004
Is Sole Proprietor?:Yes
Enumeration Date:2019-02-04
Last Update Date:2021-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD60963237152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2155649Medicaid