Provider Demographics
NPI:1437274065
Name:KHONG, STEPHEN (OD)
Entity Type:Individual
Prefix:
First Name:STEPHEN
Middle Name:
Last Name:KHONG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3575 W WALNUT ST
Mailing Address - Street 2:SUITE C
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-6208
Mailing Address - Country:US
Mailing Address - Phone:972-272-9455
Mailing Address - Fax:
Practice Address - Street 1:3575 W WALNUT ST
Practice Address - Street 2:SUITE C
Practice Address - City:GARLAND
Practice Address - State:TX
Practice Address - Zip Code:75042-6208
Practice Address - Country:US
Practice Address - Phone:972-272-9455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXTX5573T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX918176OtherBLOCK
TX9722729455OtherVSP
TXTX5573OtherEYEMED
TX11585OtherSPECTERA
TX83269EMedicare ID - Type UnspecifiedMEDICARE
TXTX5573OtherEYEMED