Healthcare Provider Details

I. General information

NPI: 1538148002
Provider Name (Legal Business Name): ANNE R BARBER O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 01/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 4TH ST SE SUITE C
PUYALLUP WA
98372-3269
US

IV. Provider business mailing address

312 4TH ST SE SUITE C
PUYALLUP WA
98372-3269
US

V. Phone/Fax

Practice location:
  • Phone: 253-435-9005
  • Fax: 253-435-9007
Mailing address:
  • Phone: 253-435-9005
  • Fax: 253-435-9007

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License NumberWA 1794
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: