Provider Demographics
NPI:1619171527
Name:GOO, STEPHEN G (OD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:G
Last Name:GOO
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8032 35TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98115-4815
Mailing Address - Country:US
Mailing Address - Phone:206-523-6676
Mailing Address - Fax:206-523-7900
Practice Address - Street 1:8032 35TH AVE NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98115-4815
Practice Address - Country:US
Practice Address - Phone:206-523-6676
Practice Address - Fax:206-523-7900
Is Sole Proprietor?:No
Enumeration Date:2007-06-13
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3262152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU63212Medicare UPIN
WA8858290Medicare PIN