Organization
LIBERTY LAKE EYECARE CENTER PS
Active
Organization subpart
No
Provider details
NPI number
Authorized official
BRET ALLEN ULRICH OD (PRESIDENT)
(509) 893-7574
Entity
Organization
Contact information
Practice address
22011 E COUNTRY VISTA DR STE 101, LIBERTY LAKE, WA 99019-5242
(154) 178-6332
(509) 893-3703
Mailing address
2207 N MOLTER RD, SUITE 100, LIBERTY LAKE, WA 99019-7571
(509) 893-7574
(509) 893-3703
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2023067
—
WA
Enumeration date
08/15/2006
Last updated
09/17/2021
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