Provider Demographics
NPI:1609038629
Name:ONG, KATHY (OD)
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:ONG
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 1:1127 4TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:SAN RAFAEL
Mailing Address - State:CA
Mailing Address - Zip Code:94901-3006
Mailing Address - Country:US
Mailing Address - Phone:415-295-7811
Mailing Address - Fax:
Practice Address - Street 1:1127 4TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:SAN RAFAEL
Practice Address - State:CA
Practice Address - Zip Code:94901-3006
Practice Address - Country:US
Practice Address - Phone:415-295-7811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-30
Last Update Date:2016-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11936T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist