Provider Demographics
NPI:1730250168
Name:RAVAL, ROSHNEE GIRISH (OD)
Entity type:Individual
Prefix:
First Name:ROSHNEE
Middle Name:GIRISH
Last Name:RAVAL
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6582
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98008-0582
Mailing Address - Country:US
Mailing Address - Phone:630-935-0865
Mailing Address - Fax:
Practice Address - Street 1:310 31ST AVE SE
Practice Address - Street 2:
Practice Address - City:PUYALLUP
Practice Address - State:WA
Practice Address - Zip Code:98374-1232
Practice Address - Country:US
Practice Address - Phone:253-770-6336
Practice Address - Fax:253-770-6903
Is Sole Proprietor?:No
Enumeration Date:2006-11-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD3983152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist