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General NPI Number Information
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NPI Number | 1164474151
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Entity Type | Individual
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Provider Name | ANGELA HEATHER MASON-TRIEBOLD O.D.
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Gender | Female
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Dates
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Enumeration Date | 05/17/2006
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Last Update Date | 02/19/2014
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Provider Practice Location Address
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Address Line | 9040 A FITZSIMMONS DR
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City | TACOMA
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State | WA
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Zip | 98431-0001
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Country | US
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Telephone | 253-968-5516
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Fax |
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Provider Business Mailing Address
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Address Line | 14520 86TH AVE E
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City | PUYALLUP
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State | WA
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Zip | 98375-6906
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Country | US
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Telephone | 253-848-3956
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3670
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License Number State | WA
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