Provider Demographics
NPI:1245373828
Name:LESLIE J. LUNG, O.D.
Entity type:Organization
Organization Name:LESLIE J. LUNG, O.D.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LESLIE
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:LUNG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:206-281-9100
Mailing Address - Street 1:535 4TH AVE W
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-3906
Mailing Address - Country:US
Mailing Address - Phone:206-281-9100
Mailing Address - Fax:206-281-9100
Practice Address - Street 1:535 4TH AVE W
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-3906
Practice Address - Country:US
Practice Address - Phone:206-281-9100
Practice Address - Fax:206-281-9100
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-14
Last Update Date:2008-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA1730152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2003598Medicaid
WA0537070001Medicare NSC
WA2003598Medicaid