Healthcare Provider Details

I. General information

NPI: 1740913375
Provider Name (Legal Business Name): PEI WEN HUA OD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/01/2022
Last Update Date: 08/16/2023
Certification Date: 08/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

340 NE NORTHGATE WAY
SEATTLE WA
98125
US

IV. Provider business mailing address

2926 103RD PL SE
EVERETT WA
98208-4530
US

V. Phone/Fax

Practice location:
  • Phone: 206-210-5963
  • Fax:
Mailing address:
  • Phone: 510-676-9809
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number61319176
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: