Individual provider Active NPI

CHI Wai Wong, O.D.

  • Optometrist
  • Renton, WA
National Provider Identifier
1912192709
Registry record updated May 2, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
WA3732 Issued in WA
Practice address
321 Burnett Ave S Ste 100
Renton, WA 98057-2569
Phone
(425) 277-0500
Fax
(425) 277-0501
NPI assigned
Sep 13, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on May 2, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Optometrist 152W00000X WA3732 WA Primary

Addresses

Primary practice location

321 Burnett Ave S Ste 100
Renton, WA 98057-2569

Mailing address

321 Burnett Ave S Ste 100
Renton, WA 98057-2569
Phone (425) 277-0500

Other identifiers 1

IdentifierTypeStateIssuer
2012191MedicaidWA

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
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20040406000046 WA Practitioner - Optometry 4789576943 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Optometry
Education
University of Missouri St Louis - School of Optometry, 2002
Medicare assignment
Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

321 Burnett Ave S
Suite 100
Renton, WA 98057-2569
Phone (425) 277-0500

Procedures performed for Medicare patients

ProcedureNumber of procedures
Cataract surgery1-10

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
WA3732WAMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Doris Wong OD PS Optometrist CurrentSince Oct 1, 2003 Accepting new patients
Luxottica Retail North America Inc Past Accepting new patients

Locations

26019 104th Ave SE
Ste 101
Kent, WA 98030
Phone (253) 520-0390

321 Burnett Ave S
Ste 100
Renton, WA 98057
Phone (425) 277-0500

17629 108th Ave SE
Renton, WA 98055
Phone (425) 277-0500

Organizations & group practices 2

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.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1189641600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682985600000",
    "number": "1912192709",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "321 BURNETT AVE S STE 100",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980572569",
            "telephone_number": "425-277-0500",
            "fax_number": "425-277-0501"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "321 BURNETT AVE S STE 100",
            "city": "RENTON",
            "state": "WA",
            "postal_code": "980572569",
            "telephone_number": "425-277-0500",
            "fax_number": "425-277-0501"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WONG",
        "first_name": "CHI WAI",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-09-13",
        "last_updated": "2023-05-02",
        "certification_date": "2022-01-13",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "WA",
            "license": "WA3732",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "2012191",
            "state": "WA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Renton, WA

Sources for this page

Verify at the official NPI Registry.