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General NPI Number Information
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NPI Number | 1760502041
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Entity Type | Organization
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Legal Business Name | MICHAEL H TAM
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Dates
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Enumeration Date | 03/30/2007
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Last Update Date | 05/01/2012
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Provider Practice Location Address
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Address Line | 400 SOUTHCENTER MALL THE SEARS BUILDING
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City | TUKWILA
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State | WA
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Zip | 98188-2811
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Country | US
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Telephone | 425-876-4868
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Fax |
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Provider Business Mailing Address
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Address Line | 3405 PARK AVE N
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City | RENTON
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State | WA
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Zip | 98056-1914
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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 | OPTOMETRIST
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Name | MICHAEL TAM
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Credential | OD
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Telephone | 425-876-4868
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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 | 3507TX
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License Number State | WA
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