Provider Demographics
NPI:1073966479
Name:LY, CAM MY (OD)
Entity Type:Individual
Prefix:DR
First Name:CAM
Middle Name:MY
Last Name:LY
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4125 ARCTIC AVE
Mailing Address - Street 2:
Mailing Address - City:BELLINGHAM
Mailing Address - State:WA
Mailing Address - Zip Code:98226-9325
Mailing Address - Country:US
Mailing Address - Phone:360-812-7015
Mailing Address - Fax:360-812-7019
Practice Address - Street 1:4125 ARCTIC AVE
Practice Address - Street 2:
Practice Address - City:BELLINGHAM
Practice Address - State:WA
Practice Address - Zip Code:98226-9325
Practice Address - Country:US
Practice Address - Phone:360-812-7015
Practice Address - Fax:360-812-7019
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-20
Last Update Date:2023-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT33373152W00000X
WA60944749152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOPT33373OtherLICENSE
WA60944749OtherLICENSE