Basic Information
| Provider Information | |||||||||
| NPI: | 1972854222 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BASHA | ||||||||
| FirstName: | FIRAS | ||||||||
| MiddleName: | OMAR | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11364 SE 82ND AVE | ||||||||
| Address2: | SUITE 402 | ||||||||
| City: | HAPPY VALLEY | ||||||||
| State: | OR | ||||||||
| PostalCode: | 970867637 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5033055084 | ||||||||
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| Practice Location | |||||||||
| Address1: | 8101 NE PARKWAY DR STE D2&D4 | ||||||||
| Address2: | |||||||||
| City: | VANCOUVER | ||||||||
| State: | WA | ||||||||
| PostalCode: | 986627911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3603146900 | ||||||||
| FaxNumber: | 3604339180 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/26/2012 | ||||||||
| LastUpdateDate: | 08/20/2019 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 3533ATI | OR | N | Eye and Vision Services Providers | Optometrist | 152W00000X | OD60376580 | WA | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.