Provider Demographics
NPI:1467584177
Name:LYMAN, DOUGLAS WARD (OD)
Entity Type:Individual
Prefix:DR
First Name:DOUGLAS
Middle Name:WARD
Last Name:LYMAN
Suffix:
Gender:M
Credentials:OD
Other - Prefix:MR
Other - First Name:DOUGLAS
Other - Middle Name:WARD
Other - Last Name:LYMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:12020 N NEWPORT HWY
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99218-1655
Mailing Address - Country:US
Mailing Address - Phone:509-444-0004
Mailing Address - Fax:509-468-1119
Practice Address - Street 1:12020 N NEWPORT HWY
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99218-1655
Practice Address - Country:US
Practice Address - Phone:509-444-0004
Practice Address - Fax:509-468-1119
Is Sole Proprietor?:No
Enumeration Date:2007-03-09
Last Update Date:2020-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1807TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
G000304706Medicare ID - Type Unspecified
U20849Medicare UPIN