Provider Demographics
NPI:1518647171
Name:LILLY, MIKI (DO)
Entity Type:Individual
Prefix:
First Name:MIKI
Middle Name:
Last Name:LILLY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1400 164TH ST SW
Mailing Address - Street 2:
Mailing Address - City:LYNNWOOD
Mailing Address - State:WA
Mailing Address - Zip Code:98087-8515
Mailing Address - Country:US
Mailing Address - Phone:425-741-8856
Mailing Address - Fax:425-741-8297
Practice Address - Street 1:1400 164TH ST SW
Practice Address - Street 2:
Practice Address - City:LYNNWOOD
Practice Address - State:WA
Practice Address - Zip Code:98087-8515
Practice Address - Country:US
Practice Address - Phone:425-741-8856
Practice Address - Fax:425-741-8297
Is Sole Proprietor?:No
Enumeration Date:2023-07-19
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60209048156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician