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General NPI Number Information
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NPI Number | 1003858358
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Entity Type | Organization
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Legal Business Name | EYE MDS OF PUGET SOUND PLLC
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Dates
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Enumeration Date | 06/12/2006
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Last Update Date | 02/14/2024
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Provider Practice Location Address
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Address Line | 4707 S 19TH ST SUITE 210
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City | TACOMA
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State | WA
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Zip | 98405-1151
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Country | US
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Telephone | 253-272-4600
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Fax | 253-272-6289
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Provider Business Mailing Address
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Address Line | 4707 S 19TH ST SUITE 210
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City | TACOMA
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State | WA
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Zip | 98405-1151
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Country | US
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Telephone | 253-272-4600
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Fax | 253-272-6289
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MELINDA BLACKWELL
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Credential |
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Telephone | 253-442-2234
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207W00000X
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Taxonomy Name | Ophthalmology Physician
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License Number |
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License Number State |
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