Provider Demographics
NPI:1689766529
Name:KWONG, HERMAN ANTHONY (OD)
Entity Type:Individual
Prefix:DR
First Name:HERMAN
Middle Name:ANTHONY
Last Name:KWONG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1520 SCENIC HWY N
Mailing Address - Street 2:
Mailing Address - City:SNELLVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30078-2130
Mailing Address - Country:US
Mailing Address - Phone:770-979-2198
Mailing Address - Fax:770-979-8382
Practice Address - Street 1:1520 SCENIC HWY N
Practice Address - Street 2:
Practice Address - City:SNELLVILLE
Practice Address - State:GA
Practice Address - Zip Code:30078-2130
Practice Address - Country:US
Practice Address - Phone:770-979-2198
Practice Address - Fax:770-979-8382
Is Sole Proprietor?:No
Enumeration Date:2006-09-29
Last Update Date:2015-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA1934152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
GAU75386Medicare UPIN