Healthcare Provider Details

I. General information

NPI: 1568957884
Provider Name (Legal Business Name): TINA ZHU OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2018
Last Update Date: 05/12/2021
Certification Date: 05/12/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19389 N 59TH AVE
GLENDALE AZ
85308
US

IV. Provider business mailing address

700 LILLY RD NE
OLYMPIA WA
98506-5115
US

V. Phone/Fax

Practice location:
  • Phone: 623-537-6000
  • Fax: 623-537-6014
Mailing address:
  • Phone: 360-923-7650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT-002266
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD60963014
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: