Provider Demographics
NPI:1538235262
Name:KVAMME, THOMAS A (OD)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:A
Last Name:KVAMME
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 1:1201 SO UNION AVE SUITE 5
Mailing Address - Street 2:1201 SO UNION AVE SUITE 5
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-1916
Mailing Address - Country:US
Mailing Address - Phone:253-756-6495
Mailing Address - Fax:253-274-9361
Practice Address - Street 1:1201 SO UNION AVE SUITE 5
Practice Address - Street 2:1201 SO UNION AVE SUITE 5
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-1916
Practice Address - Country:US
Practice Address - Phone:253-756-6495
Practice Address - Fax:253-274-9361
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-27
Last Update Date:2017-04-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1727TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2006351Medicaid
WA0059882OtherL AND I
WAKV2000OtherREGENCE
001001588Medicare ID - Type Unspecified
WA2006351Medicaid