Provider Demographics
NPI:1609024413
Name:WONG, ALLEN (OD)
Entity Type:Individual
Prefix:DR
First Name:ALLEN
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 1:7060 S DURANGO DR
Mailing Address - Street 2:STE 112
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2268
Mailing Address - Country:US
Mailing Address - Phone:702-451-0098
Mailing Address - Fax:
Practice Address - Street 1:7060 S DURANGO DR STE 112
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-2268
Practice Address - Country:US
Practice Address - Phone:702-362-2020
Practice Address - Fax:702-362-0320
Is Sole Proprietor?:No
Enumeration Date:2008-09-04
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV630152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1609024413Medicaid