Healthcare Provider Details

I. General information

NPI: 1689895930
Provider Name (Legal Business Name): HONG WANG OPTICIAN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/02/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 NORTHGATE WY #561
SEATTLE WA
98125
US

IV. Provider business mailing address

1802 N 165 ST
SHORELINE WA
98133
US

V. Phone/Fax

Practice location:
  • Phone: 206-367-0509
  • Fax: 206-364-0898
Mailing address:
  • Phone: 206-367-0509
  • Fax: 206-364-0898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code156FX1100X
TaxonomyOphthalmic Technician/Technologist
License NumberDO 1872
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: