Provider Demographics
NPI:1144499351
Name:CHUEN Y WONG
Entity type:Organization
Organization Name:CHUEN Y WONG
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELINDA
Authorized Official - Middle Name:S
Authorized Official - Last Name:BROWER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:360-785-3861
Mailing Address - Street 1:PO BOX 67
Mailing Address - Street 2:
Mailing Address - City:WINLOCK
Mailing Address - State:WA
Mailing Address - Zip Code:98596-0067
Mailing Address - Country:US
Mailing Address - Phone:360-785-3861
Mailing Address - Fax:360-785-3831
Practice Address - Street 1:118 SE FIRST STREET
Practice Address - Street 2:
Practice Address - City:WINLOCK
Practice Address - State:WA
Practice Address - Zip Code:98596
Practice Address - Country:US
Practice Address - Phone:360-785-3861
Practice Address - Fax:360-785-3831
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-22
Last Update Date:2008-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOL 599 TX332H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332H00000XSuppliersEyewear Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0333930001Medicare NSC