Provider Demographics
NPI:1659360394
Name:TOVAREK, STACY LYNN (OD)
Entity Type:Individual
Prefix:DR
First Name:STACY
Middle Name:LYNN
Last Name:TOVAREK
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:STACY
Other - Middle Name:LYNN
Other - Last Name:PAUL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:PO BOX 2020
Mailing Address - Street 2:
Mailing Address - City:GIG HARBOR
Mailing Address - State:WA
Mailing Address - Zip Code:98335-4020
Mailing Address - Country:US
Mailing Address - Phone:253-851-2020
Mailing Address - Fax:
Practice Address - Street 1:3220 UDDENBERG LN
Practice Address - Street 2:SUITE 5
Practice Address - City:GIG HARBOR
Practice Address - State:WA
Practice Address - Zip Code:98335-5128
Practice Address - Country:US
Practice Address - Phone:253-851-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-10-16
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA03945152W00000X
WY280T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP00375324OtherRAILROAD MEDICARE PIN
WA2030989Medicaid
WAU87844Medicare UPIN
WA2030989Medicaid