MEDICARE: RYLEE RAE DONOVAN OD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	70053128	WA

General Provider Information

NPI Number	:	1710779624
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	RYLEE RAE DONOVAN OD

Provider Business Mailing Address
First Line	:	2735 TUSCANY LN SW APT 821
Second Line	:
City	:	TUMWATER
State	:	WA
Zip	:	98512-7859
Country	:	US
Telephone Number	:	360-529-7196
Fax Number	:

Provider Business Practice Location Address
First Line	:	409 CUSTER WAY SE
Second Line	:
City	:	TUMWATER
State	:	WA
Zip	:	98501-3350
Country	:	US
Telephone Number	:	360-228-2733
Fax Number	:	360-252-8173

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/19/2025
Last Update Date	:	04/07/2026

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Directions to “ RYLEE RAE DONOVAN OD” Practice Location

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