Provider Demographics
NPI:1821001256
Name:ULRICH, BRET ALLEN (OD)
Entity type:Individual
Prefix:DR
First Name:BRET
Middle Name:ALLEN
Last Name:ULRICH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2207 N MOLTER RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-7571
Mailing Address - Country:US
Mailing Address - Phone:509-893-7574
Mailing Address - Fax:509-893-3703
Practice Address - Street 1:22011 E COUNTRY VISTA DR
Practice Address - Street 2:STE 101
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-5242
Practice Address - Country:US
Practice Address - Phone:509-893-7574
Practice Address - Fax:509-893-3703
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2020-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDODP844152W00000X
WAOD00002071152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2028173Medicaid
WAGAB40226Medicare PIN
U36849Medicare UPIN