Provider Demographics
NPI:1679050009
Name:TONG, JIANLIANG (OD)
Entity Type:Individual
Prefix:
First Name:JIANLIANG
Middle Name:
Last Name:TONG
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 1:1523 RIVER CHASE TRL
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-5394
Mailing Address - Country:US
Mailing Address - Phone:713-703-7387
Mailing Address - Fax:
Practice Address - Street 1:3350 BUFORD DR
Practice Address - Street 2:
Practice Address - City:BUFORD
Practice Address - State:GA
Practice Address - Zip Code:30519-4991
Practice Address - Country:US
Practice Address - Phone:713-703-7387
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-28
Last Update Date:2018-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GAOPT003119152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist