Provider Demographics
NPI:1013936574
Name:BURRELL-VERBARG, TAMELA RENEE (OD)
Entity type:Individual
Prefix:DR
First Name:TAMELA
Middle Name:RENEE
Last Name:BURRELL-VERBARG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:TAMMY
Other - Middle Name:R
Other - Last Name:BURRELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:1516 HUDSON ST NW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98502-9022
Mailing Address - Country:US
Mailing Address - Phone:360-919-3061
Mailing Address - Fax:
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:360-360-6024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-18
Last Update Date:2024-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT11939T152W00000X
COOPT.0003341152W00000X
WAOD6100320152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0119391Medicaid
CO1013936574Medicaid
CASD0119390Medicaid
CASD0119390Medicaid