Provider Demographics
NPI:1003194234
Name:WONG, JAMIE (OD)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5372 PORT SAILWOOD DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:CA
Mailing Address - Zip Code:94560-2667
Mailing Address - Country:US
Mailing Address - Phone:510-797-8770
Mailing Address - Fax:510-797-3926
Practice Address - Street 1:1895 MOWRY AVE
Practice Address - Street 2:STE 117
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1736
Practice Address - Country:US
Practice Address - Phone:510-797-8770
Practice Address - Fax:510-797-3926
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-21
Last Update Date:2022-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14219152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist