Provider Demographics
NPI:1114017043
Name:WONG, CECILIA (OD)
Entity Type:Individual
Prefix:DR
First Name:CECILIA
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2821 PECK RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:EL MONTE
Mailing Address - State:CA
Mailing Address - Zip Code:91733-2476
Mailing Address - Country:US
Mailing Address - Phone:626-443-8226
Mailing Address - Fax:626-443-9108
Practice Address - Street 1:2821 PECK RD
Practice Address - Street 2:SUITE D
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91733-2476
Practice Address - Country:US
Practice Address - Phone:626-443-8226
Practice Address - Fax:626-443-9108
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA10792T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0107920Medicaid
CASD0107920Medicaid