Provider Demographics
NPI:1902930126
Name:BOULIERIS, HELAINA YVONNE STANYER (OD)
Entity Type:Individual
Prefix:DR
First Name:HELAINA
Middle Name:YVONNE STANYER
Last Name:BOULIERIS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 N PINES RD
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-4936
Mailing Address - Country:US
Mailing Address - Phone:509-926-6800
Mailing Address - Fax:509-926-4041
Practice Address - Street 1:1103 N PINES RD
Practice Address - Street 2:
Practice Address - City:SPOKANE VALLEY
Practice Address - State:WA
Practice Address - Zip Code:99206-4936
Practice Address - Country:US
Practice Address - Phone:509-926-6800
Practice Address - Fax:509-926-4041
Is Sole Proprietor?:No
Enumeration Date:2007-03-16
Last Update Date:2024-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1874152WV0400X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1021852Medicaid
WA2009249Medicaid
WA1021852Medicaid
WA2009249Medicaid
WAG000342512Medicare ID - Type Unspecified