Provider Demographics
NPI:1659350460
Name:LAULAINEN, EDWARD WILLIAM (O D)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:WILLIAM
Last Name:LAULAINEN
Suffix:
Gender:M
Credentials:O D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 89
Mailing Address - Street 2:
Mailing Address - City:KELSO
Mailing Address - State:WA
Mailing Address - Zip Code:98626-0102
Mailing Address - Country:US
Mailing Address - Phone:360-414-8000
Mailing Address - Fax:360-414-1100
Practice Address - Street 1:209 WEST MAIN ST.
Practice Address - Street 2:SUITE 100
Practice Address - City:KELSO
Practice Address - State:WA
Practice Address - Zip Code:98626-4406
Practice Address - Country:US
Practice Address - Phone:360-414-8000
Practice Address - Fax:360-414-1100
Is Sole Proprietor?:No
Enumeration Date:2006-01-10
Last Update Date:2023-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA91-1709384152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1015611Medicaid
WAG8897443OtherMEDICARE PTAN