Provider Demographics
NPI:1265514871
Name:BILYK, LARYSA K (OD)
Entity type:Individual
Prefix:DR
First Name:LARYSA
Middle Name:K
Last Name:BILYK
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 1:45 W LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003-1408
Mailing Address - Country:US
Mailing Address - Phone:610-642-1637
Mailing Address - Fax:484-417-6389
Practice Address - Street 1:45 W LANCASTER AVE
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:PA
Practice Address - Zip Code:19003-1408
Practice Address - Country:US
Practice Address - Phone:610-642-1637
Practice Address - Fax:484-417-6389
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-20
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG-003114152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0151450001OtherMEDICARE SUPPLIER
103098ZBJ9Medicare PIN