Individual
TIMOTHY M NIVALA
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
5821 S SPRAGUE CT, TACOMA, WA 98409-6903
(253) 396-4200
Mailing address
5821 S SPRAGUE CT, TACOMA, WA 98409-6903
(253) 396-4200
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OD00001854
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2014140
—
WA
Enumeration date
01/19/2007
Last updated
05/26/2021
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