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General NPI Number Information
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NPI Number | 1356441588
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Entity Type | Individual
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Provider Name | TAWNYA JEAN PASTUCK O.D.
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Gender | Female
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Dates
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Enumeration Date | 09/25/2006
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Last Update Date | 08/24/2018
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Provider Practice Location Address
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Address Line | 17720 SE MILL PLAIN BLVD SUITE 100
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City | VANCOUVER
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State | WA
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Zip | 98683
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Country | US
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Telephone | 360-823-2020
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Fax | 360-823-1036
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Provider Business Mailing Address
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Address Line | 1204 SHENANDOAH CT
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City | MARCO ISLAND
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State | FL
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Zip | 34145-5024
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Country | US
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Telephone | 904-443-1834
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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 | OD00004062
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License Number State | WA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3173ATI
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License Number State | OR
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | OPC4527
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License Number State | FL
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