Healthcare Provider Details

I. General information

NPI: 1225080070
Provider Name (Legal Business Name): ROBERT L ULLAND O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2006
Last Update Date: 06/19/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9520 N NEWPORT HWY
SPOKANE WA
99218-1219
US

IV. Provider business mailing address

23302 E DESMET CT
LIBERTY LAKE WA
99019-8539
US

V. Phone/Fax

Practice location:
  • Phone: 509-466-6871
  • Fax: 509-466-0546
Mailing address:
  • Phone: 509-979-5324
  • Fax: 509-466-0546

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number3092T
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: