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General NPI Number Information
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NPI Number | 1235204587
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Entity Type | Organization
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Legal Business Name | TERESA A E WILLS OD
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Dates
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Enumeration Date | 11/22/2006
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Last Update Date | 10/22/2007
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Provider Practice Location Address
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Address Line | 900 MERIDIAN AVE E STE 18
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City | MILTON
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State | WA
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Zip | 98354-7003
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Country | US
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Telephone | 253-927-5252
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Fax | 253-927-4270
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Provider Business Mailing Address
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Address Line | 900 MERIDIAN AVE E STE 18
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City | MILTON
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State | WA
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Zip | 98354-7003
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Country | US
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Telephone | 253-927-5252
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Fax | 253-927-4270
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Authorized Official
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Title or Position | OWNER
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Name | TERESA A ERICKSON
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Credential | OD
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Telephone | 253-927-5252
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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 | OD00003106
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License Number State | WA
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