MEDICARE: DR DAVID LASATER OD LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	WA1915	WA

General Provider Information

NPI Number	:	1326068818
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DR DAVID LASATER OD LLC

Provider Business Mailing Address
First Line	:	2517 NATALIE LANE
Second Line	:
City	:	STEILACOOM
State	:	WA
Zip	:	98388
Country	:	US
Telephone Number	:	360-809-0214
Fax Number	:	855-817-9696

Provider Business Practice Location Address
First Line	:	2517 NATALIE LANE
Second Line	:
City	:	STEILACOOM
State	:	WA
Zip	:	98388
Country	:	US
Telephone Number	:	360-809-0214
Fax Number	:	855-817-9696

Authorized Official
Title or Position	:	OWNER
Name	:	DR. DAVID LASATER
Credential	:	O.D.
Telephone Number	:	360-809-0214

Provider Enumeration Date	:	07/20/2006
Last Update Date	:	01/20/2011

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