Basic Information
| Provider Information | |||||||||
| NPI: | 1003804014 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | POOL | ||||||||
| FirstName: | TONY | ||||||||
| MiddleName: | D. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8502 MAIN ST | ||||||||
| Address2: | UNIT E-102 | ||||||||
| City: | EDMONDS | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980266971 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256708458 | ||||||||
| FaxNumber: | 4257400991 | ||||||||
| Practice Location | |||||||||
| Address1: | 543 MAIN ST | ||||||||
| Address2: | SUITE C | ||||||||
| City: | EDMONDS | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980203162 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4256708458 | ||||||||
| FaxNumber: | 4257400991 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2005 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | X | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 1877TX | WA | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.