Basic Information
| Provider Information | |||||||||
| NPI: | 1679821177 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | GABRIELSON | ||||||||
| FirstName: | SARAH | ||||||||
| MiddleName: | MARIE | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1007 39TH AVE SE | ||||||||
| Address2: | PUYALLUP MEDICAL CENTER | ||||||||
| City: | PUYALLUP | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983742192 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534353100 | ||||||||
| FaxNumber: | 2534353138 | ||||||||
| Practice Location | |||||||||
| Address1: | 1007 39TH AVE SE | ||||||||
| Address2: | |||||||||
| City: | PUYALLUP | ||||||||
| State: | WA | ||||||||
| PostalCode: | 983742192 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2534353200 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/15/2012 | ||||||||
| LastUpdateDate: | 04/07/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 04/07/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | OD60291691 | WA | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.