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General NPI Number Information
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NPI Number | 1427450030
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Entity Type | Organization
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Legal Business Name | TOM & ANTHONY LLC
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Dates
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Enumeration Date | 09/25/2014
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Last Update Date | 12/30/2014
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Provider Practice Location Address
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Address Line | 509 N SULLIVAN RD STE G
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City | SPOKANE VALLEY
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State | WA
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Zip | 99037-8566
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Country | US
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Telephone | 509-922-0633
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1975
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City | POST FALLS
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State | ID
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Zip | 83877-1975
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Country | US
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Telephone | 208-818-4362
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | ANTHONY LOPEZ
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Credential | O.D.
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Telephone | 509-922-0633
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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 | OD60478733
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License Number State | WA
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