Provider Demographics
NPI:1417114539
Name:WONG, YUK FUNG (LIC OPTICAN)
Entity Type:Individual
Prefix:MS
First Name:YUK FUNG
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:LIC OPTICAN
Other - Prefix:MS
Other - First Name:SANDY
Other - Middle Name:
Other - Last Name:WONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LIC OPTICAN
Mailing Address - Street 1:8319 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ELMHURST
Mailing Address - State:NY
Mailing Address - Zip Code:11373-5720
Mailing Address - Country:US
Mailing Address - Phone:718-271-1782
Mailing Address - Fax:718-271-8769
Practice Address - Street 1:83-19 BROADWAY
Practice Address - Street 2:
Practice Address - City:ELMHURST
Practice Address - State:NY
Practice Address - Zip Code:11373-5720
Practice Address - Country:US
Practice Address - Phone:718-271-1782
Practice Address - Fax:718-271-8769
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-16
Last Update Date:2008-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYC007533-1156FX1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes156FX1800XEye and Vision Services ProvidersTechnician/TechnologistOptician