Healthcare Provider Details

I. General information

NPI: 1114750098
Provider Name (Legal Business Name): JEREMY TEE OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2024
Last Update Date: 09/02/2025
Certification Date: 09/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1705 S 324TH PL
FEDERAL WAY WA
98003-8504
US

IV. Provider business mailing address

1705 S 324TH PL
FEDERAL WAY WA
98003-8504
US

V. Phone/Fax

Practice location:
  • Phone: 253-661-6005
  • Fax: 253-661-0633
Mailing address:
  • Phone: 253-661-6005
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number11263
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberOD61675916
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: