Tanya Victoria Petruk, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OD.OD.70055125 Issued in WA

Practice address

8160 Freedom LN NE
Unit D
Lacey, WA 98516

Phone

(360) 455-4425

NPI assigned

Nov 19, 2025

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in WA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Other, 2023

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Aeg Washington Professional PCGroup PAC ID 3476927997, 61 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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

• Aeg Washington Professional PC

  • Optometrist
  • Bellevue, WA
  • NPI 1134835176
  Medicare reassignment Care Compare group NPD

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

{
    "created_epoch": "1763510400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1763510400000",
    "number": "1487515474",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3201 PACIFIC AVE",
            "address_2": "UNIT 105",
            "city": "TACOMA",
            "state": "WA",
            "postal_code": "98418"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8160 FREEDOM LN NE",
            "address_2": "UNIT D",
            "city": "LACEY",
            "state": "WA",
            "postal_code": "98516",
            "telephone_number": "360-455-4425"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PETRUK",
        "first_name": "TANYA",
        "middle_name": "VICTORIA",
        "credential": "OD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2025-11-19",
        "last_updated": "2025-11-19",
        "certification_date": "2025-11-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD.OD.70055125",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Peterson and Cammack, D.D.S., P.L.L.C
• Donald Peterson, MA-P
• Lahela Minerbi Peterson, LMHCA
• Sandra Anne Peterson
• Venn R Peterson, D.D.S.
• Quoc T Phan, MD
• Dana Lee Phillips, LMP
• Robin D Phillips, LMP
• Jennifer Marie Piazza
• Mary Ellen Piccoli, LMT, LMP

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 19, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.