Provider Demographics
NPI:1831946797
Name:TULALIP TRIBES OF WASHINGTON
Entity type:Organization
Organization Name:TULALIP TRIBES OF WASHINGTON
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EYE CLINIC LEAD
Authorized Official - Prefix:
Authorized Official - First Name:EMILY
Authorized Official - Middle Name:
Authorized Official - Last Name:BENHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-716-5660
Mailing Address - Street 1:6406 MARINE DR STE A
Mailing Address - Street 2:
Mailing Address - City:TULALIP
Mailing Address - State:WA
Mailing Address - Zip Code:98271-9775
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7520 TOTEM BEACH RD
Practice Address - Street 2:
Practice Address - City:TULALIP
Practice Address - State:WA
Practice Address - Zip Code:98271-6160
Practice Address - Country:US
Practice Address - Phone:360-716-4511
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TULALIP TRIBES OF WASHINGTON
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-04-30
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Multi-Specialty