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General NPI Number Information
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NPI Number | 1194906248
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Entity Type | Organization
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Legal Business Name | TACOMA EYECARE CENTER INC
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Dates
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Enumeration Date | 11/16/2007
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Last Update Date | 04/26/2011
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Provider Practice Location Address
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Address Line | 9115 S TACOMA WAY STE 106
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City | TACOMA
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State | WA
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Zip | 98499-4400
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Country | US
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Telephone | 253-588-4225
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Fax | 253-588-4402
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Provider Business Mailing Address
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Address Line | 9115 S TACOMA WAY STE 106
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City | TACOMA
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State | WA
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Zip | 98499-4400
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Country | US
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Telephone | 253-588-4225
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Fax | 253-588-4402
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Authorized Official
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Title or Position | OWNER
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Name | JASON I GIM
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Credential | O.D.
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Telephone | 253-588-4225
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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 | 3284
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License Number State | WA
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