Provider Demographics
NPI:1689987612
Name:DONG, DAVIN DENNIS (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVIN
Middle Name:DENNIS
Last Name:DONG
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 1:156 W 28TH ST
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10001-6125
Mailing Address - Country:US
Mailing Address - Phone:212-244-5536
Mailing Address - Fax:212-244-5318
Practice Address - Street 1:156 W 28TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10001-6125
Practice Address - Country:US
Practice Address - Phone:212-244-5536
Practice Address - Fax:212-244-5318
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-19
Last Update Date:2016-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY007586152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist