Provider Demographics
NPI:1497716294
Name:WONG, LAURENCE C (OD)
Entity Type:Individual
Prefix:DR
First Name:LAURENCE
Middle Name:C
Last Name:WONG
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 1:22762 WESTHEIMER PKWY STE 405
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-8825
Mailing Address - Country:US
Mailing Address - Phone:281-395-2010
Mailing Address - Fax:
Practice Address - Street 1:22762 WESTHEIMER PKWY STE 405
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-8825
Practice Address - Country:US
Practice Address - Phone:281-395-2010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6270TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F1828Medicare ID - Type Unspecified
V07583Medicare UPIN
TX8F5653Medicare PIN