Healthcare Provider Details

I. General information

NPI: 1467475236
Provider Name (Legal Business Name): DAVID LASATER O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/25/2006
Last Update Date: 12/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5900 LITTLEROCK RD SW
TUMWATER WA
98512-7355
US

IV. Provider business mailing address

5900 LITTLEROCK RD SW
TUMWATER WA
98512-7355
US

V. Phone/Fax

Practice location:
  • Phone: 360-350-6024
  • Fax: 360-943-6981
Mailing address:
  • Phone: 360-350-6024
  • Fax: 360-943-6981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberWA1915
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: