Provider Demographics
NPI:1003804014
Name:POOL, TONY D (OD)
Entity Type:Individual
Prefix:DR
First Name:TONY
Middle Name:D
Last Name:POOL
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8502 MAIN ST
Mailing Address - Street 2:UNIT E-102
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-6971
Mailing Address - Country:US
Mailing Address - Phone:425-670-8458
Mailing Address - Fax:425-740-0991
Practice Address - Street 1:543 MAIN ST
Practice Address - Street 2:SUITE C
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-3162
Practice Address - Country:US
Practice Address - Phone:425-670-8458
Practice Address - Fax:425-740-0991
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1877TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAAB37245Medicare ID - Type Unspecified
WAT90583Medicare UPIN