Provider Demographics
NPI:1548462419
Name:NGO, MICHELLE PM (OD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:PM
Last Name:NGO
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:PHUONG MAI
Other - Last Name:NGO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:412 12TH AVE S
Mailing Address - Street 2:#205
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98144-2032
Mailing Address - Country:US
Mailing Address - Phone:206-329-5700
Mailing Address - Fax:206-329-4894
Practice Address - Street 1:412 12TH AVE S
Practice Address - Street 2:#205
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98144-2032
Practice Address - Country:US
Practice Address - Phone:206-329-5700
Practice Address - Fax:206-329-4894
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA2089152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2020337Medicaid
WAU39930Medicare UPIN