Brian W Sullivan, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

OD00001680 Issued in WA

Practice address

215 Lilly Rd NE
Olympia, WA 98506-5030

Phone

(360) 456-4800

Fax

(360) 456-4812

NPI assigned

Dec 19, 2006

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1166486400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1184787988",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "215 LILLY RD NE",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065030",
            "telephone_number": "360-456-4800",
            "fax_number": "360-456-4812"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "215 LILLY RD NE",
            "city": "OLYMPIA",
            "state": "WA",
            "postal_code": "985065030",
            "telephone_number": "360-456-4800",
            "fax_number": "360-456-4812"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SULLIVAN",
        "first_name": "BRIAN",
        "middle_name": "W",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-19",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "OD00001680",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2011971",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Daryl Sudasena
• Ronald K Sugiyama, MD
• David Suguitan, LMHC, LCPC
• Kirk Edward Sulenes, R.PH.
• Anna Kathleen Sullivan
• Caitlin Sullivan, LMFT
• Corey Sullivan, MD
• Edward Braddock Sullivan
• George Sullivan, C.A.R. L.M.P.
• Grace Mary Sullivan

• Optometrist in Olympia, WA
• Providers in Olympia, WA by specialty
• Optometrist in Washington

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.