Provider Demographics
NPI:1285700484
Name:MAXEY-WONG, LINDA ANN (OD)
Entity type:Individual
Prefix:DR
First Name:LINDA
Middle Name:ANN
Last Name:MAXEY-WONG
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 1:1940 BLACK LAKE BLVD SW
Mailing Address - Street 2:
Mailing Address - City:OLYMPIA
Mailing Address - State:WA
Mailing Address - Zip Code:98512-5651
Mailing Address - Country:US
Mailing Address - Phone:360-570-1780
Mailing Address - Fax:360-570-1801
Practice Address - Street 1:1940 BLACK LAKE BLVD SW
Practice Address - Street 2:
Practice Address - City:OLYMPIA
Practice Address - State:WA
Practice Address - Zip Code:98512-5651
Practice Address - Country:US
Practice Address - Phone:360-570-1780
Practice Address - Fax:360-570-1801
Is Sole Proprietor?:No
Enumeration Date:2006-11-28
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD0002094152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2030542Medicaid
WAU37976Medicare UPIN
WA2030542Medicaid