Provider Demographics
NPI:1689234577
Name:LAI, ANDY C (OD)
Entity Type:Individual
Prefix:DR
First Name:ANDY
Middle Name:C
Last Name:LAI
Suffix:
Gender:M
Credentials:OD
Other - Prefix:DR
Other - First Name:ANDY
Other - Middle Name:C
Other - Last Name:LAI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:4325 UNIVERSITY WAY NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98105-5808
Mailing Address - Country:US
Mailing Address - Phone:206-633-5225
Mailing Address - Fax:
Practice Address - Street 1:4325 UNIVERSITY WAY NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-5808
Practice Address - Country:US
Practice Address - Phone:206-633-5225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-13
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60911230152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist