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General NPI Number Information
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NPI Number | 1003950494
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Entity Type | Individual
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Provider Name | LAWRENCE PEI-WEN WANG
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Gender | Male
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Dates
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Enumeration Date | 02/18/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 16735 SE 272ND ST SUITE C
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City | COVINGTON
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State | WA
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Zip | 98042-4942
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Country | US
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Telephone | 253-639-4077
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1834
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City | ISSAQUAH
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State | WA
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Zip | 98027-0075
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Country | US
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Telephone | 425-687-7981
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 3495
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License Number State | WA
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