Provider Demographics
NPI:1710035068
Name:FONG, DON P (OD)
Entity Type:Individual
Prefix:DR
First Name:DON
Middle Name:P
Last Name:FONG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:3956 J ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-3625
Mailing Address - Country:US
Mailing Address - Phone:916-739-6260
Mailing Address - Fax:916-739-0168
Practice Address - Street 1:3956 J ST
Practice Address - Street 2:SUITE 4
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-3625
Practice Address - Country:US
Practice Address - Phone:916-739-6260
Practice Address - Fax:916-739-0168
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-05
Last Update Date:2015-11-22
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA06920T152W00000X, 152WL0500X
NJ270A00377600152W00000X
PAOE005239P152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1710035068OtherNPI
CASD0069200Medicaid
0790040001OtherPTAN
CAT10440Medicare UPIN