Provider Demographics
NPI:1164468211
Name:WONG, KEYE L (MD)
Entity Type:Individual
Prefix:
First Name:KEYE
Middle Name:L
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:3920 BEE RIDGE RD
Mailing Address - Street 2:BLDG D
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-1207
Mailing Address - Country:US
Mailing Address - Phone:941-924-0303
Mailing Address - Fax:941-924-0309
Practice Address - Street 1:3920 BEE RIDGE RD
Practice Address - Street 2:BLDG D
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-1207
Practice Address - Country:US
Practice Address - Phone:941-924-0303
Practice Address - Fax:941-924-0309
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2021-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME56535207W00000X, 207WX0107X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207WX0107XAllopathic & Osteopathic PhysiciansOphthalmologyRetina Specialist
No207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL062311300Medicaid
FL062311300Medicaid
D43527Medicare UPIN
P00460805Medicare PIN