Provider Demographics
NPI:1104286020
Name:TACOMA EYECARE CENTER, INC
Entity type:Organization
Organization Name:TACOMA EYECARE CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:I
Authorized Official - Last Name:GIM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-588-4225
Mailing Address - Street 1:9115 SO. TACOMA WAY 106
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98499
Mailing Address - Country:US
Mailing Address - Phone:253-588-4225
Mailing Address - Fax:253-588-4402
Practice Address - Street 1:9990 MICKELBERRY RD NW
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383
Practice Address - Country:US
Practice Address - Phone:360-692-7372
Practice Address - Fax:360-337-2393
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-04
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA3284261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service