Provider Demographics
NPI:1366277931
Name:HAYTER, OLYVIA NICOLE
Entity type:Individual
Prefix:
First Name:OLYVIA
Middle Name:NICOLE
Last Name:HAYTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:505 CEDAR AVE STE B1
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98270-4561
Mailing Address - Country:US
Mailing Address - Phone:425-760-1446
Mailing Address - Fax:
Practice Address - Street 1:505 CEDAR AVE STE B1
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:WA
Practice Address - Zip Code:98270-4561
Practice Address - Country:US
Practice Address - Phone:425-760-1446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-04
Last Update Date:2024-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61560093156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician