Individual
BRIAN W SULLIVAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
215 LILLY RD NE, OLYMPIA, WA 98506-5030
(360) 456-4800
(360) 456-4812
Mailing address
215 LILLY RD NE, OLYMPIA, WA 98506-5030
(360) 456-4800
(360) 456-4812
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OD00001680
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2011971
—
WA
Enumeration date
12/19/2006
Last updated
07/08/2007
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