Provider Demographics
NPI:1124470026
Name:DONG, JONATHAN NGUYEN (OD)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:NGUYEN
Last Name:DONG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24416 104TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:KENT
Mailing Address - State:WA
Mailing Address - Zip Code:98030-4969
Mailing Address - Country:US
Mailing Address - Phone:253-201-2515
Mailing Address - Fax:253-479-0104
Practice Address - Street 1:10725 SE 256TH ST STE 4
Practice Address - Street 2:
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98030
Practice Address - Country:US
Practice Address - Phone:253-201-2515
Practice Address - Fax:253-479-0104
Is Sole Proprietor?:No
Enumeration Date:2016-07-05
Last Update Date:2022-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD60675735152WP0200X, 152WV0400X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WV0400XEye and Vision Services ProvidersOptometristVision Therapy