Healthcare Provider Details

I. General information

NPI: 1831946797
Provider Name (Legal Business Name): TULALIP TRIBES OF WASHINGTON
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2024
Last Update Date: 07/09/2024
Certification Date: 07/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7520 TOTEM BEACH RD
TULALIP WA
98271-6160
US

IV. Provider business mailing address

6406 MARINE DR STE A
TULALIP WA
98271-9775
US

V. Phone/Fax

Practice location:
  • Phone: 360-716-4511
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: EMILY BENHAM
Title or Position: EYE CLINIC LEAD
Credential:
Phone: 360-716-5660