Provider Demographics
NPI:1871040576
Name:TEDD LOUIE, OD, LLC
Entity Type:Organization
Organization Name:TEDD LOUIE, OD, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR OF OPTOMETRY
Authorized Official - Prefix:DR
Authorized Official - First Name:TEDD
Authorized Official - Middle Name:
Authorized Official - Last Name:LOUIE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:360-412-3492
Mailing Address - Street 1:1470 MARVIN RD NE
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-3870
Mailing Address - Country:US
Mailing Address - Phone:360-412-3492
Mailing Address - Fax:360-412-3493
Practice Address - Street 1:1470 MARVIN RD NE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516-3870
Practice Address - Country:US
Practice Address - Phone:360-412-3492
Practice Address - Fax:360-412-3493
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-09
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3186152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty