Provider Demographics
NPI:1477837250
Name:J & J OPTOMETRIC SERVICES
Entity Type:Organization
Organization Name:J & J OPTOMETRIC SERVICES
Other - Org Name:WOODRIDGE VISION CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:PANDORA
Authorized Official - Last Name:NGAN
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:206-788-5560
Mailing Address - Street 1:1580 WOODRIDGE DR SE
Mailing Address - Street 2:
Mailing Address - City:PORT ORCHARD
Mailing Address - State:WA
Mailing Address - Zip Code:98366-3818
Mailing Address - Country:US
Mailing Address - Phone:360-871-7837
Mailing Address - Fax:360-871-7901
Practice Address - Street 1:1580 WOODRIDGE DR SE
Practice Address - Street 2:
Practice Address - City:PORT ORCHARD
Practice Address - State:WA
Practice Address - Zip Code:98366-3818
Practice Address - Country:US
Practice Address - Phone:360-871-7837
Practice Address - Fax:360-871-7901
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-28
Last Update Date:2012-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA4002TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAG8907223Medicare PIN