Provider Demographics
NPI:1609943182
Name:DONG, CONNIE (OD)
Entity Type:Individual
Prefix:DR
First Name:CONNIE
Middle Name:
Last Name:DONG
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 1:595 W 239TH ST
Mailing Address - Street 2:APT B3
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10463-1291
Mailing Address - Country:US
Mailing Address - Phone:646-875-8828
Mailing Address - Fax:212-320-0368
Practice Address - Street 1:25 W 43RD ST
Practice Address - Street 2:SUITE 316
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10036-7406
Practice Address - Country:US
Practice Address - Phone:646-875-8828
Practice Address - Fax:212-320-0368
Is Sole Proprietor?:No
Enumeration Date:2006-11-29
Last Update Date:2013-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYVUT005312152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2341237OtherAETNA
NYNY5312OtherEYEMED VISION CARE