Provider Demographics
NPI:1548837156
Name:GRABER, TAHLIE (OD)
Entity type:Individual
Prefix:
First Name:TAHLIE
Middle Name:
Last Name:GRABER
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:TAHLIE
Other - Middle Name:
Other - Last Name:CABLAYAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1350 GALAXY DR NE STE D
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98516-4757
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1350 GALAXY DR NE
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98516-4757
Practice Address - Country:US
Practice Address - Phone:360-918-0449
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-10
Last Update Date:2025-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD61180218152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist