Provider Demographics
NPI:1659425510
Name:LIM, WENDY W (OD)
Entity Type:Individual
Prefix:
First Name:WENDY
Middle Name:W
Last Name:LIM
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 1:17924 140TH AVE NE STE 200
Mailing Address - Street 2:
Mailing Address - City:WOODINVILLE
Mailing Address - State:WA
Mailing Address - Zip Code:98072-4315
Mailing Address - Country:US
Mailing Address - Phone:425-483-8000
Mailing Address - Fax:
Practice Address - Street 1:17924 140TH AVE NE STE 200
Practice Address - Street 2:
Practice Address - City:WOODINVILLE
Practice Address - State:WA
Practice Address - Zip Code:98072-4315
Practice Address - Country:US
Practice Address - Phone:425-483-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-22
Last Update Date:2022-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00003311152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU72361Medicare UPIN
WAG8882629Medicare PIN
WAGAB22481Medicare PIN
WAGAB29394Medicare PIN
WA2021889Medicaid