Provider Demographics
NPI:1700117116
Name:SOUND RETINA PS
Entity Type:Organization
Organization Name:SOUND RETINA PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:R
Authorized Official - Last Name:TRUXAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:253-572-1444
Mailing Address - Street 1:2245 S 19TH ST
Mailing Address - Street 2:#200
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-2945
Mailing Address - Country:US
Mailing Address - Phone:253-572-1444
Mailing Address - Fax:253-830-2528
Practice Address - Street 1:2245 S 19TH ST
Practice Address - Street 2:#200
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-2945
Practice Address - Country:US
Practice Address - Phone:253-572-1444
Practice Address - Fax:253-830-2528
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-25
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8895605OtherPTAN