Provider Demographics
NPI:1760482772
Name:CHOUS, ELIZABETH KLASCH (OD)
Entity type:Individual
Prefix:DR
First Name:ELIZABETH
Middle Name:KLASCH
Last Name:CHOUS
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 1:6720 REGENTS BLVD
Mailing Address - Street 2:
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98466
Mailing Address - Country:US
Mailing Address - Phone:253-565-9403
Mailing Address - Fax:253-565-2503
Practice Address - Street 1:6720 REGENTS BLVD
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98466-5400
Practice Address - Country:US
Practice Address - Phone:253-565-9403
Practice Address - Fax:425-432-5929
Is Sole Proprietor?:No
Enumeration Date:2005-08-01
Last Update Date:2017-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2048TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG001002298Medicare ID - Type Unspecified
WAU28904Medicare UPIN