Provider Demographics
NPI:1497159552
Name:WONG, SHARON ANN (OD)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:ANN
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 1:100 E CALIFORNIA BLVD
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3205
Mailing Address - Country:US
Mailing Address - Phone:800-898-2020
Mailing Address - Fax:626-577-2100
Practice Address - Street 1:3440 LOMITA BLVD STE 100
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4810
Practice Address - Country:US
Practice Address - Phone:562-317-3893
Practice Address - Fax:562-206-2507
Is Sole Proprietor?:No
Enumeration Date:2014-10-20
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT15137TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist