| Van B. Ly, Llc | |
|
319 7th Ave Se Suite #101 Olympia WA 98501-1325 | |
| (360) 357-2544 | |
| (360) 786-8734 |
| Full Name | Van B. Ly, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 319 7th Ave Se, Olympia, Washington |
| Authorized Official Name and Position | Van B Ly (OPTOMETRIST) |
| Authorized Official Contact | 3603572544 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Van B. Ly, Llc 319 7th Ave Se Suite #101 Olympia WA 98501-1325 Ph: (360) 357-2544 | Van B. Ly, Llc 319 7th Ave Se Suite #101 Olympia WA 98501-1325 Ph: (360) 357-2544 |
| NPI Number | 1154585024 |
|---|---|
| Provider Enumeration Date | 07/10/2008 |
| Last Update Date | 06/01/2010 |
| Medicare PECOS PAC ID | 7416021639 |
|---|---|
| Medicare Enrollment ID | O20080812000241 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1154585024 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261Q00000X | Clinic/center | 602832856 (Washington) | Primary |
| Provider Name | Van B Ly |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1386836591 PECOS PAC ID: 6103911409 Enrollment ID: I20080812000233 |
| Provider Name | Joseph Edward Wayman |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1588143143 PECOS PAC ID: 7315279619 Enrollment ID: I20191105001869 |
| Provider Name | Kyle A Benefield |
|---|---|
| Provider Type | Practitioner - Optometry |
| Provider Identifiers | NPI Number: 1396133138 PECOS PAC ID: 9436571148 Enrollment ID: I20200625003218 |
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