Provider Demographics
NPI:1649418260
Name:JOYCE L. WONG, OD, PC
Entity Type:Organization
Organization Name:JOYCE L. WONG, OD, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOYCE
Authorized Official - Middle Name:L
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:915-833-1928
Mailing Address - Street 1:7181 WESTWIND DR
Mailing Address - Street 2:STE. D
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-1782
Mailing Address - Country:US
Mailing Address - Phone:915-833-1928
Mailing Address - Fax:915-833-1933
Practice Address - Street 1:7181 WESTWIND DR
Practice Address - Street 2:STE. D
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-1782
Practice Address - Country:US
Practice Address - Phone:915-833-1928
Practice Address - Fax:915-833-1933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-04
Last Update Date:2009-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4899TG261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX093479602Medicaid