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General NPI Number Information
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NPI Number | 1306488911
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Entity Type | Organization
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Legal Business Name | PROCTOR VISION CLINIC, PLLC
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Dates
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Enumeration Date | 10/15/2019
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Last Update Date | 11/15/2019
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Provider Practice Location Address
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Address Line | 2510 N PROCTOR ST
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City | TACOMA
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State | WA
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Zip | 98406-5338
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Country | US
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Telephone | 253-301-1225
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Fax | 253-301-1228
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Provider Business Mailing Address
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Address Line | 2510 N PROCTOR ST
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City | TACOMA
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State | WA
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Zip | 98406-5338
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Country | US
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Telephone | 253-301-1225
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Fax |
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Authorized Official
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Title or Position | BILLING
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Name | KAREN BERBERICH
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Credential |
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Telephone | 253-525-2020
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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 |
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License Number State |
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