Provider Demographics
NPI:1962074310
Name:GUO, JASON (OD)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:
Last Name:GUO
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 1:34719 6TH AVE S
Mailing Address - Street 2:
Mailing Address - City:FEDERAL WAY
Mailing Address - State:WA
Mailing Address - Zip Code:98003-8714
Mailing Address - Country:US
Mailing Address - Phone:206-260-2503
Mailing Address - Fax:855-929-1515
Practice Address - Street 1:15153 5TH AVE SW
Practice Address - Street 2:
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-3072
Practice Address - Country:US
Practice Address - Phone:206-260-2503
Practice Address - Fax:855-929-1515
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-14
Last Update Date:2024-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAOD61316792152W00000X
GAOPT003350152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA2231369Medicaid