Provider Demographics
NPI:1134484330
Name:WONG, MEIMEY TAN (OD)
Entity Type:Individual
Prefix:DR
First Name:MEIMEY
Middle Name:TAN
Last Name:WONG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11700 MUKILTEO SPEEDWAY STE 501
Mailing Address - Street 2:
Mailing Address - City:MUKILTEO
Mailing Address - State:WA
Mailing Address - Zip Code:98275-5444
Mailing Address - Country:US
Mailing Address - Phone:425-745-5650
Mailing Address - Fax:425-315-8300
Practice Address - Street 1:11700 MUKILTEO SPEEDWAY STE 501
Practice Address - Street 2:
Practice Address - City:MUKILTEO
Practice Address - State:WA
Practice Address - Zip Code:98275-5444
Practice Address - Country:US
Practice Address - Phone:425-315-8300
Practice Address - Fax:425-315-8900
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-12
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA60291407152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8920736Medicare PIN