Breazeal, Larry D
Breazeal, Larry D is an individual health care provider with primary practice located at 509 N Sullivan Rd Ste G , Spokane Valley WA 99037-8566. He recently has only one registered license in Eye and Vision Services Providers / Optometrist, which is considered as his primary health care specialty. Breazeal, Larry D can be contacted via phone (509) 922-2400.Contact Information
Primary practice address
509 N Sullivan Rd Ste G
Spokane Valley WA 99037-8566
Phone: (509) 922-2400
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Eye and Vision Services Providers / Optometrist | 152W00000X | OD00003957 | Washington |
| Eye and Vision Services Providers / Optometrist | 152W00000X | ODP-1014 | Idaho |
Profile Details
| NPI number | 1619049228 |
|---|---|
| LBN Legal business name | Breazeal, Larry D |
| Credentials | Doctor of Optometry (OD) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Nov 15th, 2006 |
| Last updated | Dec 1st, 2011 - about 13 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1619049228 | NPPES |
| Washington | MEDICAID | 2029890 | |
| Washington | MEDICAID | 805604301 |
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