Individual
DR. GLEB V SUKHOVOLSKIY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
2915 S ALDER ST, TACOMA, WA 98409-4803
(253) 473-0275
(253) 473-0706
Mailing address
PO BOX 1506, CHEHALIS, WA 98532-0409
(360) 242-3008
(360) 807-7687
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OD60483702
WA
152W00000X
Optometrist
OD60483702OPT-OP
WA
152W00000X
Optometrist
OPT-OPT-LIC-3679
MT
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2121025
—
WA
Enumeration date
10/19/2011
Last updated
12/07/2020
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