Provider Demographics
NPI:1144255936
Name:BIRNBACH, CHARLES D (MD)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:D
Last Name:BIRNBACH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:22232 17TH AVE SE STE 308
Mailing Address - Street 2:
Mailing Address - City:BOTHELL
Mailing Address - State:WA
Mailing Address - Zip Code:98021-7425
Mailing Address - Country:US
Mailing Address - Phone:425-296-3837
Mailing Address - Fax:206-215-3870
Practice Address - Street 1:1750 112TH AVE NE
Practice Address - Street 2:SUITE D050
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3752
Practice Address - Country:US
Practice Address - Phone:206-215-3850
Practice Address - Fax:206-215-3870
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2023-08-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WAMD00033777207WX0107X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0288397OtherL & I FOR PROLIANCE SURGEONS, INC.
WA1119767Medicaid
WAG44524Medicare UPIN
WA1119767Medicaid