Provider Demographics
NPI:1932287869
Name:GIG HARBOR VISION CENTER PS
Entity Type:Organization
Organization Name:GIG HARBOR VISION CENTER PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CORPORATE SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:CONSTANCE
Authorized Official - Middle Name:L
Authorized Official - Last Name:WORTHEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:253-851-2020
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:253-851-7135
Practice Address - Street 1:3220 UDDENBERG LN STE 5
Practice Address - Street 2:
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:253-851-7135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMP0957829OtherDEA # STACY TOVAREK, O.D.
WAMW0710699OtherDEA # EDWARD M. WORTHEN,
WAT02874Medicare UPIN
WAMP0957829OtherDEA # STACY TOVAREK, O.D.
WAU87844Medicare UPIN