Healthcare Provider Details

I. General information

NPI: 1801355995
Provider Name (Legal Business Name): SHRISHYLA YELGAR OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2019
Last Update Date: 01/22/2025
Certification Date: 01/22/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19400 108TH AVE SE STE 202
KENT WA
98031-0108
US

IV. Provider business mailing address

19400 108TH AVE SE STE 202
KENT WA
98031-0108
US

V. Phone/Fax

Practice location:
  • Phone: 253-852-2120
  • Fax: 253-373-0201
Mailing address:
  • Phone: 253-852-2120
  • Fax: 253-373-0201

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number00882
License Number StateNY
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number61426806
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: