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Individual

ALEX ILYIN

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
OD

Contact information

Practice address
205 WEST MAIN STREET, EVERSON, WA 98247
(360) 966-0445
Mailing address
PO BOX 853, EVERSON, WA 98247-0853
(360) 966-0445

Taxonomy

Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
OD00003776
WA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
2029098
WA
Enumeration date
09/28/2006
Last updated
11/14/2012
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