Provider Demographics
NPI:1467475236
Name:LASATER, DAVID (OD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:LASATER
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 1:5900 LITTLEROCK RD SW
Mailing Address - Street 2:
Mailing Address - City:TUMWATER
Mailing Address - State:WA
Mailing Address - Zip Code:98512-7355
Mailing Address - Country:US
Mailing Address - Phone:360-350-6024
Mailing Address - Fax:360-943-6981
Practice Address - Street 1:5900 LITTLEROCK RD SW
Practice Address - Street 2:
Practice Address - City:TUMWATER
Practice Address - State:WA
Practice Address - Zip Code:98512-7355
Practice Address - Country:US
Practice Address - Phone:360-350-6024
Practice Address - Fax:360-943-6981
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2013-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA1915152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2033876Medicaid
U31714Medicare UPIN
WA2033876Medicaid