Provider Demographics
NPI:1053740225
Name:TAM-SUAREZ, PEONY CRYSTAL (OD)
Entity type:Individual
Prefix:
First Name:PEONY
Middle Name:CRYSTAL
Last Name:TAM-SUAREZ
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3710 N CENTRAL ST
Mailing Address - Street 2:
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93291-8175
Mailing Address - Country:US
Mailing Address - Phone:949-463-6707
Mailing Address - Fax:
Practice Address - Street 1:250 W 5TH ST
Practice Address - Street 2:
Practice Address - City:HANFORD
Practice Address - State:CA
Practice Address - Zip Code:93230-5029
Practice Address - Country:US
Practice Address - Phone:877-960-3426
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-07
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD 60371650152W00000X
CA15089152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAOD 60371650OtherWASHINGTON STATE DEPARTMENT OF HEALTH