Provider Demographics
NPI:1225080070
Name:ULLAND, ROBERT L (OD)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:L
Last Name:ULLAND
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23302 E DESMET CT
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-8539
Mailing Address - Country:US
Mailing Address - Phone:509-979-5324
Mailing Address - Fax:509-466-0546
Practice Address - Street 1:9520 N NEWPORT HWY
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1219
Practice Address - Country:US
Practice Address - Phone:509-466-6871
Practice Address - Fax:509-466-0546
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2014-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3092T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2005064Medicaid
WAU48439Medicare UPIN
WA2005064Medicaid