Healthcare Provider Details

I. General information

NPI: 1821549072
Provider Name (Legal Business Name): JESSICA VUONG O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/21/2016
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

23535 NE NOVELTY HILL RD # D302
REDMOND WA
98053-5502
US

IV. Provider business mailing address

18109 33RD AVE W
LYNNWOOD WA
98037-4840
US

V. Phone/Fax

Practice location:
  • Phone: 425-898-9222
  • Fax: 425-898-9225
Mailing address:
  • Phone: 425-697-1077
  • Fax: 425-697-1078

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number60687025
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: