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Contact Information

CORLISS OPTOMETRISTS
312 4TH ST SE
PUYALLUP, WA98372
 Phone: 253-845-0585
 Fax: 253-845-1939
 Website:
 

Specialty

Taxonomy Code Specialty Code Provider Type

Optometrist

152W00000X 41 Optometry
Indicates primary specialty

NPI Profile & details for CORLISS OPTOMETRISTS

NPI # 1932321296
LBN Legal business name CORLISS OPTOMETRISTS
Authorized official CLYSTA PRIETO - (BOOKKEEPER)
Entity Organization
Organization subpart 1 No
Enumeration date 05/03/2007
Last updated 03/03/2021 - About 5 years ago
Identifiers
WA License # 600080747
WA Medicaid 2211704
WA Other 0016684 DEPT OF LABOR&INDUSTRIES
1 Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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