Provider Demographics
NPI:1407426828
Name:WONG, EVELYN YEE-LAM (OD)
Entity Type:Individual
Prefix:
First Name:EVELYN
Middle Name:YEE-LAM
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 1:909 HARTFORD TPKE
Mailing Address - Street 2:
Mailing Address - City:WATERFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06385-4267
Mailing Address - Country:US
Mailing Address - Phone:860-442-0380
Mailing Address - Fax:
Practice Address - Street 1:909 HARTFORD TPKE STE D2
Practice Address - Street 2:
Practice Address - City:WATERFORD
Practice Address - State:CT
Practice Address - Zip Code:06385-4267
Practice Address - Country:US
Practice Address - Phone:860-442-0380
Practice Address - Fax:860-442-0831
Is Sole Proprietor?:No
Enumeration Date:2021-06-28
Last Update Date:2021-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT3200152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist