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General NPI Number Information
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NPI Number | 1528148327
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Entity Type | Organization
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Legal Business Name | DORIS WONG OD PS
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Dates
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Enumeration Date | 10/16/2006
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Last Update Date | 01/13/2022
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Provider Practice Location Address
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Address Line | 321 BURNETT AVE S STE 100
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City | RENTON
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State | WA
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Zip | 98057-2569
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Country | US
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Telephone | 425-277-0500
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Fax | 425-277-0501
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Provider Business Mailing Address
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Address Line | 321 BURNETT AVE S STE 100
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City | RENTON
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State | WA
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Zip | 98057-2569
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Country | US
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Telephone | 425-277-0500
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Fax | 425-277-0501
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Authorized Official
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Title or Position | PRESIDENT OPTOMETRIST
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Name | DR. CHI WAI WONG
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Credential | OD
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Telephone | 253-653-2812
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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 | 3732TX
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License Number State | WA
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