Provider Demographics
NPI:1902315856
Name:LILAC FAMILY EYE CARE, PLLC
Entity Type:Organization
Organization Name:LILAC FAMILY EYE CARE, PLLC
Other - Org Name:LILAC FAMILY EYE CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:DARNELL
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:509-210-0303
Mailing Address - Street 1:23505 E APPLEWAY AVE STE 106
Mailing Address - Street 2:
Mailing Address - City:LIBERTY LAKE
Mailing Address - State:WA
Mailing Address - Zip Code:99019-6003
Mailing Address - Country:US
Mailing Address - Phone:509-210-0303
Mailing Address - Fax:509-242-3180
Practice Address - Street 1:23505 E APPLEWAY AVE STE 106
Practice Address - Street 2:
Practice Address - City:LIBERTY LAKE
Practice Address - State:WA
Practice Address - Zip Code:99019-6003
Practice Address - Country:US
Practice Address - Phone:509-998-7127
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-09-22
Last Update Date:2018-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD60658528152W00000X
IDODP-100362152W00000X
MTOPT-OPT-LIC-2788152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty