Healthcare Provider Details

I. General information

NPI: 1548674872
Provider Name (Legal Business Name): DOUGLAS W. LYMAN, OD, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2014
Last Update Date: 06/14/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7619 N DIVISION ST
SPOKANE WA
99208-5613
US

IV. Provider business mailing address

7619 N DIVISION ST
SPOKANE WA
99208-5613
US

V. Phone/Fax

Practice location:
  • Phone: 509-444-0004
  • Fax: 509-468-1119
Mailing address:
  • Phone: 509-444-0004
  • Fax: 509-468-1119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberOD 00001807
License Number StateWA

VIII. Authorized Official

Name: DOUGLAS LYMAN
Title or Position: OPTOMETRIST
Credential: O.D.
Phone: 509-444-0004