Basic Information
| Provider Information | |||||||||
| NPI: | 1629006135 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | JAMIL | ||||||||
| FirstName: | ANNISA | ||||||||
| MiddleName: | L. | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1101 MADISON ST | ||||||||
| Address2: | STE 600 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981043501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062152020 | ||||||||
| FaxNumber: | 2062153870 | ||||||||
| Practice Location | |||||||||
| Address1: | 1101 MADISON ST | ||||||||
| Address2: | STE 600 | ||||||||
| City: | SEATTLE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 981043501 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2062152020 | ||||||||
| FaxNumber: | 2062152022 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2006 | ||||||||
| LastUpdateDate: | 08/30/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/30/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 44821 | WA | N | Allopathic & Osteopathic Physicians | Ophthalmology | 207WX0009X | MD00044821 | WA | Y |
ID Information
| ID | Type | State | Issuer | Description | 1014828 | 05 | WA | MEDICAID |