MEDICARE: SOUTH SOUND EYE CARE

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	305S00000X	Point of Service	OD00003834	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1891194718
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SOUTH SOUND EYE CARE

Provider Business Mailing Address
First Line	:	4502 S STEELE ST
Second Line	:	SUITE 304 B
City	:	TACOMA
State	:	WA
Zip	:	98409-7242
Country	:	US
Telephone Number	:	253-475-3937
Fax Number	:	855-664-7324

Provider Business Practice Location Address
First Line	:	4502 S STEELE ST
Second Line	:	SUITE 304 B
City	:	TACOMA
State	:	WA
Zip	:	98409-7242
Country	:	US
Telephone Number	:	253-475-3937
Fax Number	:	855-664-7324

Authorized Official
Title or Position	:	OWNER
Name	:	DR. GREGORY THOMAS GREER
Credential	:	O.D.
Telephone Number	:	253-475-3937

Provider Enumeration Date	:	08/15/2014
Last Update Date	:	12/19/2014

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Directions to “SOUTH SOUND EYE CARE ” Practice Location

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