Provider Demographics
NPI:1811098262
Name:WONG, ARTHUR Y (OD)
Entity type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:Y
Last Name:WONG
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 1:402 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:EDMONDS
Mailing Address - State:WA
Mailing Address - Zip Code:98020-3138
Mailing Address - Country:US
Mailing Address - Phone:425-771-7772
Mailing Address - Fax:425-775-9973
Practice Address - Street 1:402 MAIN ST
Practice Address - Street 2:
Practice Address - City:EDMONDS
Practice Address - State:WA
Practice Address - Zip Code:98020-3138
Practice Address - Country:US
Practice Address - Phone:425-771-7772
Practice Address - Fax:425-775-9973
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3276152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2024966Medicaid
WA0149513OtherL&I
WAAB20698Medicare ID - Type Unspecified
WA2024966Medicaid