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General NPI Number Information
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NPI Number | 1407803356
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Entity Type | Organization
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Legal Business Name | KENNETH C. DAHLIN, O.D., PLLC
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Dates
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Enumeration Date | 05/27/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 4502 S STEELE ST SUITE 304-B
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City | TACOMA
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State | WA
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Zip | 98409-7242
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Country | US
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Telephone | 253-472-6465
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Fax |
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Provider Business Mailing Address
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Address Line | 4502 S STEELE ST SUITE 304-B
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City | TACOMA
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State | WA
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Zip | 98409-7242
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | KENNETH DAHLIN
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Credential |
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Telephone | 253-472-6465
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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 | 1353
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License Number State | WA
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