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General NPI Number Information
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NPI Number | 1326068818
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Entity Type | Organization
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Legal Business Name | DR DAVID LASATER OD LLC
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Dates
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Enumeration Date | 07/20/2006
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Last Update Date | 01/20/2011
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Provider Practice Location Address
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Address Line | 2517 NATALIE LANE
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City | STEILACOOM
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State | WA
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Zip | 98388
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Country | US
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Telephone | 360-809-0214
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Fax | 855-817-9696
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Provider Business Mailing Address
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Address Line | 2517 NATALIE LANE
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City | STEILACOOM
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State | WA
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Zip | 98388
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Country | US
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Telephone | 360-809-0214
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Fax | 855-817-9696
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Authorized Official
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Title or Position | OWNER
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Name | DR. DAVID LASATER
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Credential | O.D.
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Telephone | 360-809-0214
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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 | WA1915
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License Number State | WA
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