Provider Demographics
NPI:1689354557
Name:THOMAS FONG II, OD, INC
Entity Type:Organization
Organization Name:THOMAS FONG II, OD, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:
Authorized Official - Last Name:FONG
Authorized Official - Suffix:II
Authorized Official - Credentials:OD
Authorized Official - Phone:916-451-4494
Mailing Address - Street 1:5623 FREEPORT BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95822-3501
Mailing Address - Country:US
Mailing Address - Phone:916-451-4494
Mailing Address - Fax:916-451-4229
Practice Address - Street 1:5623 FREEPORT BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95822-3501
Practice Address - Country:US
Practice Address - Phone:916-451-4494
Practice Address - Fax:916-451-4229
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-07-24
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Multi-Specialty
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact ManagementGroup - Multi-Specialty