Provider Demographics
NPI:1154982106
Name:CHAN, GORETTI WAI YAN (OD)
Entity type:Individual
Prefix:
First Name:GORETTI
Middle Name:WAI YAN
Last Name:CHAN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14926 NE 72ND CT
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-6805
Mailing Address - Country:US
Mailing Address - Phone:425-698-0210
Mailing Address - Fax:
Practice Address - Street 1:4010 172ND ST NE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:WA
Practice Address - Zip Code:98223-8482
Practice Address - Country:US
Practice Address - Phone:360-386-4612
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-20
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD60969761152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist