Provider Demographics
NPI:1164474151
Name:MASON-TRIEBOLD, ANGELA HEATHER (OD)
Entity Type:Individual
Prefix:DR
First Name:ANGELA
Middle Name:HEATHER
Last Name:MASON-TRIEBOLD
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:ANGELA
Other - Middle Name:HEATHER
Other - Last Name:TRIEBOLD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:14520 86TH AVE E
Mailing Address - Street 2:
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98375-6906
Mailing Address - Country:US
Mailing Address - Phone:253-848-3956
Mailing Address - Fax:
Practice Address - Street 1:9040 A FITZSIMMONS DR
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-0001
Practice Address - Country:US
Practice Address - Phone:253-968-5516
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2014-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3670152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist