Provider Demographics
NPI:1730370073
Name:WEBER, ERIC L (CPO)
Entity type:Individual
Prefix:
First Name:ERIC
Middle Name:L
Last Name:WEBER
Suffix:
Gender:M
Credentials:CPO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:723 MARTIN LUTHER KING JR WAY
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98405-4139
Mailing Address - Country:US
Mailing Address - Phone:253-383-4447
Mailing Address - Fax:253-593-7980
Practice Address - Street 1:723 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98405-4139
Practice Address - Country:US
Practice Address - Phone:253-383-4447
Practice Address - Fax:253-593-7980
Is Sole Proprietor?:No
Enumeration Date:2007-08-01
Last Update Date:2009-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOI00000393222Z00000X
WAPS00000434224P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes224P00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersProsthetist
No222Z00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersOrthotist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8476293Medicaid