Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 3495 | WA |
NPI | 1003950494 |
---|---|
Provider Name | Lawrence Pei-Wen Wang |
First Address | Issaquah, WA 98027-0075 |
Second Address | Covington, WA 98042-4942 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/02/2007 |
Last Update Date | 09/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
2030690 | (05) | WA |
U95910 | (02) | WA |
WA1418 | REGENCE BLUE SHIELD (01) | WA |