Individual
DR. TARA S. WATERBURY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
8705 S TACOMA WAY, LAKEWOOD, WA 98499-4544
(253) 582-3698
Mailing address
9905 134TH ST E, #11-208, PUYALLUP, WA 98373-5664
(253) 268-0827
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4020TX
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2031326
—
WA
Enumeration date
02/22/2007
Last updated
07/08/2007
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