Organization
D. TODD WYLIE, O.D., INC.
Active
Other names
Advanced Eyecare Center
Organization subpart
No
Provider details
NPI number
Authorized official
DR. DONALD TODD WYLIE OD (OWNER)
(509) 535-5855
Entity
Organization
Contact information
Practice address
104 S FREYA STREET, SUITE 220, WHITE FLAG BLDG, SPOKANE, WA 99202-4867
(509) 535-5855
(509) 535-3916
Mailing address
104 S FREYA STREET, SUITE 220, WHITE FLAG BLDG, SPOKANE, WA 99202-4867
(509) 535-5855
(509) 535-3916
Taxonomy
Speciality
Code
Description
License number
State
261Q00000X
Clinic/Center
Primary
1528TX
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2024842
—
WA
01
—
GAB20237
MEDICARE
WA
Enumeration date
10/19/2007
Last updated
03/21/2019
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