Provider Demographics
NPI:1063447498
Name:WONG, TONY (OD)
Entity Type:Individual
Prefix:DR
First Name:TONY
Middle Name:
Last Name:WONG
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 1:15350 BEL RED RD UNIT 130
Mailing Address - Street 2:
Mailing Address - City:REDMOND
Mailing Address - State:WA
Mailing Address - Zip Code:98052-7366
Mailing Address - Country:US
Mailing Address - Phone:425-562-2015
Mailing Address - Fax:425-562-2010
Practice Address - Street 1:15350 BEL RED RD UNIT 130
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98052-7366
Practice Address - Country:US
Practice Address - Phone:425-562-2015
Practice Address - Fax:425-562-2010
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2023-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAWA3422TX152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAU77395Medicare UPIN