Provider Demographics
NPI:1699865790
Name:ANDERSON, DENNIS WALWYN (OD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:WALWYN
Last Name:ANDERSON
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1901 S 72ND ST
Mailing Address - Street 2:SUITE 17
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98408-1200
Mailing Address - Country:US
Mailing Address - Phone:253-474-4700
Mailing Address - Fax:
Practice Address - Street 1:1901 S 72ND ST
Practice Address - Street 2:SUITE 17
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98408-1200
Practice Address - Country:US
Practice Address - Phone:253-474-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00001075152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist