Provider Demographics
NPI:1083915532
Name:KUO-EVELAND, WENDY (OD)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:
Last Name:KUO-EVELAND
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:CHI-WEN
Other - Middle Name:
Other - Last Name:KUO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:4575 NE 4TH ST STE 2
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98059-5054
Mailing Address - Country:US
Mailing Address - Phone:425-970-3230
Mailing Address - Fax:
Practice Address - Street 1:4575 NE 4TH ST STE 2
Practice Address - Street 2:
Practice Address - City:RENTON
Practice Address - State:WA
Practice Address - Zip Code:98059-5054
Practice Address - Country:US
Practice Address - Phone:425-970-3230
Practice Address - Fax:425-970-3533
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-14
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD601797790152W00000X
WA60179790152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty