Organization
WATERBURY VISION CLINIC LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TARA WATERBURY OD (MEMBER)
(253) 617-8514
Entity
Organization
Contact information
Practice address
4505 S 19TH ST, TACOMA, WA 98405-1183
(253) 752-3961
Mailing address
4505 S 19TH ST, TACOMA, WA 98405-1183
(253) 752-3961
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
4020
WA
Other
Enumeration date
01/31/2015
Last updated
01/31/2015
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