Healthcare Provider Details

I. General information

NPI: 1003739350
Provider Name (Legal Business Name): ALYSSA LEE OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/03/2026
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

625 BLACK LAKE BLVD SW STE 110
OLYMPIA WA
98502-8603
US

IV. Provider business mailing address

2043 COLLEGE WAY
FOREST GROVE OR
97116-1756
US

V. Phone/Fax

Practice location:
  • Phone: 360-357-2542
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number70119106
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: