Provider Demographics
NPI:1659620516
Name:WONG, VICKY WING LAI (OD)
Entity Type:Individual
Prefix:DR
First Name:VICKY
Middle Name:WING LAI
Last Name:WONG
Suffix:
Gender:F
Credentials:OD
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Mailing Address - Street 1:15200 SHADY GROVE RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-3218
Mailing Address - Country:US
Mailing Address - Phone:301-670-1212
Mailing Address - Fax:301-216-9692
Practice Address - Street 1:15200 SHADY GROVE RD
Practice Address - Street 2:SUITE 100
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-3218
Practice Address - Country:US
Practice Address - Phone:301-670-1212
Practice Address - Fax:301-216-9692
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-06
Last Update Date:2013-07-16
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PAOEG002678152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist