Provider Demographics
NPI:1588616221
Name:WONG, ARTHUR (OD)
Entity Type:Individual
Prefix:DR
First Name:ARTHUR
Middle Name:
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 1:3004 SW 98TH WAY
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-8682
Mailing Address - Country:US
Mailing Address - Phone:954-214-1952
Mailing Address - Fax:
Practice Address - Street 1:5415 SW 64TH ST
Practice Address - Street 2:COMPENSATION & PENSION SERVICE-VA CLINIC
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-9605
Practice Address - Country:US
Practice Address - Phone:352-338-4900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-17
Last Update Date:2011-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOPC-3068152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL620223300Medicaid