Healthcare Provider Details

I. General information

NPI: 1790708790
Provider Name (Legal Business Name): BARRY G HUSE OD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 10/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2913 S 38TH ST STE B3
TACOMA WA
98409-5629
US

IV. Provider business mailing address

2913 S 38TH ST SUITE B-3
TACOMA WA
98409-5629
US

V. Phone/Fax

Practice location:
  • Phone: 253-473-1050
  • Fax: 253-473-2338
Mailing address:
  • Phone: 253-473-1050
  • Fax: 253-473-2338

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number00001918
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number1918
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: