Tara S. Waterbury

Primary specialty

OptometristTaxonomy code 152W00000X

License

4020TX Issued in WA

Practice address

8705 S Tacoma Way
Lakewood, WA 98499-4544

Phone

(253) 582-3698

NPI assigned

Feb 22, 2007

Last updated

Jul 8, 2007By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Eyejoa Optical, LLC

  dba Eyejoa Optical

  • Optometrist
  • Lakewood, WA
  • NPI 1194850925
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1172102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1215062021",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9905 134TH ST E",
            "address_2": "#11-208",
            "city": "PUYALLUP",
            "state": "WA",
            "postal_code": "983735664",
            "telephone_number": "253-268-0827"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8705 S TACOMA WAY",
            "city": "LAKEWOOD",
            "state": "WA",
            "postal_code": "984994544",
            "telephone_number": "253-582-3698"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WATERBURY",
        "first_name": "TARA",
        "middle_name": "S.",
        "name_prefix": "Dr.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "4020TX",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2031326",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Washington Dental Corporation, PC (Lakewood Dentist Office)
• Washington Practice Management, LLC
• Allisa Lee Washington, AA
• Caden Washington
• Natasha Lavette Washington, LMHC
• William Robert Waters
• Rachel Watkins
• Rhonda Sue Watkins, CDP
• Alexis Jeanlefon Watson, LPN
• Amanda Leigh Watson

• Optometrist in Lakewood, WA
• Providers in Lakewood, WA by specialty
• Optometrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.