Individual
DR. KATHLEEN R WONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
402 MAIN ST, EDMONDS, WA 98020-3138
(425) 771-7772
(425) 775-9973
Mailing address
201 5TH AVE S, STE 102, EDMONDS, WA 98020-3646
(425) 771-7772
(425) 775-9973
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
3268
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0149513
L&I
WA
05
—
2024537
—
WA
Enumeration date
09/26/2006
Last updated
04/17/2018
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