Active NPI
Randy Lai Yuu Wong, O.D.
- Optometrist
- Edmonds, WA
National Provider Identifier
1457345563
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Optometrist
- License
- OD00003999
- Practice address
- 22511 Highway 99
Ste 112
Edmonds, WA 98026-8398 - Phone
- (425) 670-9888
- Fax
- (425) 670-2402
- NPI assigned
- Sep 2, 2005
- Reactivated
- Apr 6, 2006
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Optometrist | 152W00000X | OD00003999 | WA | Primary |
Addresses
Primary practice location
22511 Highway 99
Ste 112
Edmonds, WA 98026-8398
Mailing address
22511 Highway 99 112
Edmonds, WA 98026-8398
Phone (425) 670-9888
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 2033587 | Medicaid | WA |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WA
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Optometry
- Education
- University of California - School of Optometry, 2005
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
22511 Hwy 99
Suite 112
Edmonds, WA 98026-8398
Phone (425) 670-9888
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Optometrist
- Edmonds, WA
- NPI 1922123124
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1125619200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1547510400000",
"number": "1457345563",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "22511 HIGHWAY 99 112",
"city": "EDMONDS",
"state": "WA",
"postal_code": "980268398",
"telephone_number": "425-670-9888",
"fax_number": "425-670-2402"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "22511 HIGHWAY 99",
"address_2": "STE 112",
"city": "EDMONDS",
"state": "WA",
"postal_code": "980268398",
"telephone_number": "425-670-9888",
"fax_number": "425-670-2402"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WONG",
"first_name": "RANDY",
"middle_name": "LAI YUU",
"name_prefix": "Dr.",
"credential": "O.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2005-09-02",
"last_updated": "2019-01-15",
"deactivation_date": "2006-03-24",
"reactivation_date": "2006-04-06",
"status": "A"
},
"taxonomies": [
{
"code": "152W00000X",
"taxonomy_group": "",
"desc": "Optometrist",
"state": "WA",
"license": "OD00003999",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "2033587",
"state": "WA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Edmonds, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 15, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.