Provider Demographics
NPI:1083769905
Name:ONG, PHILIP (OD)
Entity Type:Individual
Prefix:DR
First Name:PHILIP
Middle Name:
Last Name:ONG
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 1:6531 CROWN BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95120-2906
Mailing Address - Country:US
Mailing Address - Phone:408-997-2020
Mailing Address - Fax:408-904-7655
Practice Address - Street 1:6531 CROWN BLVD STE 4
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95120-2906
Practice Address - Country:US
Practice Address - Phone:408-997-2020
Practice Address - Fax:408-904-7655
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-23
Last Update Date:2007-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA7548T152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAU26188Medicare UPIN