Provider Demographics
NPI:1376709303
Name:KOK, WENDY (OD)
Entity Type:Individual
Prefix:DR
First Name:WENDY
Middle Name:
Last Name:KOK
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 1:1125 COMMONWEALTH AVE
Mailing Address - Street 2:APT #31
Mailing Address - City:ALLSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02134-3201
Mailing Address - Country:US
Mailing Address - Phone:617-276-5694
Mailing Address - Fax:
Practice Address - Street 1:1457 WHALLEY AVE
Practice Address - Street 2:
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06515-1153
Practice Address - Country:US
Practice Address - Phone:203-562-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT002753152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist