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General NPI Number Information
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NPI Number | 1871542449
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Entity Type | Organization
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Legal Business Name | MAMIE WONG O.D. PLLC
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Dates
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Enumeration Date | 05/09/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 10000 AURORA AVE N SUITE #6
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City | SEATTLE
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State | WA
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Zip | 98133-9346
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Country | US
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Telephone | 206-524-5768
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Fax |
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Provider Business Mailing Address
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Address Line | 10000 AURORA AVE N SUITE #6
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City | SEATTLE
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State | WA
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Zip | 98133-9346
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Country | US
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Telephone | 206-524-5768
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Fax |
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Authorized Official
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Title or Position | SOLE MEMBER
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Name | DR. MAMIE WONG
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Credential | O.D.
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Telephone | 206-524-5768
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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 | 2005
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License Number State | WA
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