Provider Demographics
NPI:1003914151
Name:WONG, TIEN (MD)
Entity Type:Individual
Prefix:
First Name:TIEN
Middle Name:
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6560 FANNIN ST
Mailing Address - Street 2:STE 750
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77030-2727
Mailing Address - Country:US
Mailing Address - Phone:713-524-3434
Mailing Address - Fax:713-524-3220
Practice Address - Street 1:6560 FANNIN ST
Practice Address - Street 2:STE 750
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77030-2727
Practice Address - Country:US
Practice Address - Phone:713-524-3434
Practice Address - Fax:713-524-3220
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH3961207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX4310136OtherAETNA
TX80G068OtherBLUE SHIELD
TXE89756OtherSTERLING OPTION ONE
TX101319501Medicaid
LA1534421Medicaid
TX19422OtherOPTICARE
TXH3961OtherUNICARE
TX10019568OtherAMERIGROUP
TX101319502Medicaid
TX26010OtherSELECTCARE OF TEXAS
TX10019568OtherAMERIVANTAGE
TX80G068OtherBLUE SHIELD
TX4310136OtherAETNA
TXE89756OtherSTERLING OPTION ONE
LA5Y817Medicare PIN
TX10019568OtherAMERIVANTAGE
TX101319502Medicaid