Provider Demographics
NPI:1295015832
Name:GUNN, ANNA MARIE (OD)
Entity Type:Individual
Prefix:DR
First Name:ANNA
Middle Name:MARIE
Last Name:GUNN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:ANNA MARIE
Other - Middle Name:
Other - Last Name:LUEBBERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1703 S MERIDIAN
Mailing Address - Street 2:SUITE 101
Mailing Address - City:PUYALLUP
Mailing Address - State:WA
Mailing Address - Zip Code:98371-7590
Mailing Address - Country:US
Mailing Address - Phone:253-838-3000
Mailing Address - Fax:253-845-8750
Practice Address - Street 1:5225 CIRQUE DR W
Practice Address - Street 2:SUITE 200
Practice Address - City:UNIVERSITY PLACE
Practice Address - State:WA
Practice Address - Zip Code:98467-3604
Practice Address - Country:US
Practice Address - Phone:253-848-3000
Practice Address - Fax:253-845-8750
Is Sole Proprietor?:No
Enumeration Date:2011-08-26
Last Update Date:2017-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60223150152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2016615Medicaid
WAP01224972Medicare PIN