Provider Demographics
NPI:1790708790
Name:HUSE, BARRY G (OD)
Entity Type:Individual
Prefix:DR
First Name:BARRY
Middle Name:G
Last Name:HUSE
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 1:2913 S 38TH ST
Mailing Address - Street 2:SUITE B-3
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-5629
Mailing Address - Country:US
Mailing Address - Phone:253-473-1050
Mailing Address - Fax:253-473-2338
Practice Address - Street 1:2913 S 38TH ST STE B3
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-5629
Practice Address - Country:US
Practice Address - Phone:253-473-1050
Practice Address - Fax:253-473-2338
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-25
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1918152WC0802X
WA00001918152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2016053Medicaid
WAGAB39051Medicare PIN
WA2016053Medicaid