Provider Demographics
NPI:1922123124
Name:VISIONAIRE, LLC
Entity Type:Organization
Organization Name:VISIONAIRE, LLC
Other - Org Name:VISIONAIRE EYECARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT & OPTOMETRIC PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:LY
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:206-390-8089
Mailing Address - Street 1:22511 HIGHWAY 99
Mailing Address - Street 2:SUITE 112
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98026-8379
Mailing Address - Country:US
Mailing Address - Phone:425-670-9888
Mailing Address - Fax:425-670-2402
Practice Address - Street 1:22511 HIGHWAY 99
Practice Address - Street 2:SUITE 112
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98026-8379
Practice Address - Country:US
Practice Address - Phone:425-670-9888
Practice Address - Fax:425-670-2402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD00003999152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty