Provider Demographics
NPI:1760667695
Name:BARRY HUSE OD & ASSOCIATES PS
Entity type:Organization
Organization Name:BARRY HUSE OD & ASSOCIATES PS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:G
Authorized Official - Last Name:HUSE
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:253-473-1050
Mailing Address - Street 1:2913 S 38TH ST
Mailing Address - Street 2:SUITE B-3
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98409-5629
Mailing Address - Country:US
Mailing Address - Phone:253-473-1050
Mailing Address - Fax:253-473-2338
Practice Address - Street 1:2913 S 38TH ST
Practice Address - Street 2:SUITE B-3
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98409-5629
Practice Address - Country:US
Practice Address - Phone:253-473-1050
Practice Address - Fax:253-473-2338
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1918261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAGAB39052OtherMEDICARE GROUP NUMBER
WA2016053Medicaid
WAGAB39052OtherMEDICARE GROUP NUMBER