MEDICARE: WASHINGTON PACIFIC EYE ASSOCIATES INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	MD 00043816	WA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	25919	OTHER		SPECTERA
2	2240697	OTHER		FIRST HEALTH
3	213138	OTHER		ECPA
4	95266	OTHER		CHPW/PEBB
5	3555339	OTHER	WA	AETNA HMO
6	0190004	OTHER		LABOR INDUSTRIES
7	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
8	213138	OTHER		EYE CARE PLAN OF AMERICA
9	2240697	OTHER	WA	FIRST HEALTH/CNN
10	50847	OTHER		DAVID VISION
11	WA1035	OTHER		NORTHWEST

General Provider Information

NPI Number	:	1588763494
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WASHINGTON PACIFIC EYE ASSOCIATES INC.

Provider Business Mailing Address
First Line	:	134 CENTRAL WAY
Second Line	:
City	:	KIRKLAND
State	:	WA
Zip	:	98033-6106
Country	:	US
Telephone Number	:	425-889-2020
Fax Number	:	425-734-0601

Provider Business Practice Location Address
First Line	:	134 CENTRAL WAY
Second Line	:
City	:	KIRKLAND
State	:	WA
Zip	:	98033-6106
Country	:	US
Telephone Number	:	425-889-2020
Fax Number	:	425-734-0601

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	DR. JENNIFER JUNG YUN LEE
Credential	:	M.D.
Telephone Number	:	425-889-2020

Provider Enumeration Date	:	09/21/2006
Last Update Date	:	08/31/2011

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