Healthcare Provider Details

I. General information

NPI: 1083915532
Provider Name (Legal Business Name): WENDY KUO-EVELAND O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CHI-WEN KUO O.D.

II. Dates (important events)

Enumeration Date: 11/14/2010
Last Update Date: 02/19/2024
Certification Date: 02/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4575 NE 4TH ST STE 2
RENTON WA
98059-5054
US

IV. Provider business mailing address

4575 NE 4TH ST STE 2
RENTON WA
98059-5054
US

V. Phone/Fax

Practice location:
  • Phone: 425-970-3230
  • Fax: 425-970-3533
Mailing address:
  • Phone: 425-970-3230
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD601797790
License Number StateWA
# 2
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number60179790
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: