Organization
CORLISS OPTOMETRISTS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. CLYSTA C PRIETO (BOOKKEEPER)
(253) 845-0587
Entity
Organization
Contact information
Practice address
312 4TH ST SE, PUYALLUP, WA 98372
(253) 845-0585
(253) 845-1939
Mailing address
PO BOX 1266, PUYALLUP, WA 98371-0237
(253) 845-0585
(253) 845-1939
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
600080747
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0016684
DEPT OF LABOR&INDUSTRIES
WA
05
—
2211704
—
WA
Enumeration date
05/03/2007
Last updated
03/03/2021
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