Healthcare Provider Details

I. General information

NPI: 1982971172
Provider Name (Legal Business Name): MICHELE BAYLE L.D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/16/2011
Last Update Date: 11/16/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4854 RAINIER AVE S
SEATTLE WA
98118-1742
US

IV. Provider business mailing address

4854 RAINIER AVE S
SEATTLE WA
98118-1742
US

V. Phone/Fax

Practice location:
  • Phone: 206-722-3939
  • Fax: 206-826-9140
Mailing address:
  • Phone: 206-722-3939
  • Fax: 206-826-9140

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1800X
TaxonomyOptician
License NumberDO00001681
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: