Healthcare Provider Details

I. General information

NPI: 1861318669
Provider Name (Legal Business Name): PACIFIC NORTHWEST OPTOMETRY PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2026
Last Update Date: 06/25/2026
Certification Date: 06/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 5TH ST
CLARKSTON WA
99403-1860
US

IV. Provider business mailing address

14205 SE 36TH ST STE 100
BELLEVUE WA
98006-1553
US

V. Phone/Fax

Practice location:
  • Phone: 509-758-0205
  • Fax: 509-751-4086
Mailing address:
  • Phone: 425-738-7870
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number
License Number State

VIII. Authorized Official

Name: SANDY WONG-TRAN
Title or Position: MEMBER
Credential: O.D.
Phone: 425-738-7870