Provider Demographics
NPI:1780729442
Name:LOUIE, TEDD (OD)
Entity type:Individual
Prefix:
First Name:TEDD
Middle Name:
Last Name:LOUIE
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 1:1470 MARVIN ROAD 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
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-20
Last Update Date:2016-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3186152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist