Provider Demographics
NPI:1437225430
Name:EDMONDS VISION CENTER PS INC
Entity Type:Organization
Organization Name:EDMONDS VISION CENTER PS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ARTHUR
Authorized Official - Middle Name:YING
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:425-771-7772
Mailing Address - Street 1:201 5TH AVE S STE 102
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-3646
Mailing Address - Country:US
Mailing Address - Phone:425-771-7772
Mailing Address - Fax:425-775-9973
Practice Address - Street 1:201 5TH AVE S STE 102
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020
Practice Address - Country:US
Practice Address - Phone:425-771-7772
Practice Address - Fax:425-775-9973
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3276152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2024537Medicaid
WA2024958Medicaid
WA2024966Medicaid
WA2024966Medicaid
WA84458Medicare UPIN
WAGAB20700Medicare ID - Type UnspecifiedGROUP #
WAGAB20698Medicare ID - Type UnspecifiedDR ARTHUR Y WONG
WA2024958Medicaid