Provider Demographics
NPI:1700841012
Name:LO, PHILIP S (OD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:S
Last Name:LO
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 1:20 BOSTON ST
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98109-2319
Mailing Address - Country:US
Mailing Address - Phone:206-282-8120
Mailing Address - Fax:206-282-8046
Practice Address - Street 1:20 BOSTON ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98109
Practice Address - Country:US
Practice Address - Phone:206-282-8120
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00003729152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2031672Medicaid
P00395087OtherRAILROAD MEDICARE
WA0206232OtherLABOR & INDUSTRIES
P00395087OtherRAILROAD MEDICARE
WAG8860820Medicare PIN
WA0206232OtherLABOR & INDUSTRIES
U92010Medicare UPIN