Healthcare Provider Details

I. General information

NPI: 1457287211
Provider Name (Legal Business Name): ANDREW LOISEL OD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

16708 BOTHELL EVERETT HWY STE 103
MILL CREEK WA
98012-6345
US

IV. Provider business mailing address

16708 BOTHELL EVERETT HWY STE 103
MILL CREEK WA
98012-6345
US

V. Phone/Fax

Practice location:
  • Phone: 425-481-4440
  • Fax:
Mailing address:
  • Phone: 425-481-4440
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD.OD.70142364
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: