Provider Demographics
NPI:1750853412
Name:WONG, YVONNE CHI (OD)
Entity Type:Individual
Prefix:DR
First Name:YVONNE
Middle Name:CHI
Last Name:WONG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12 TREVOR PL
Mailing Address - Street 2:
Mailing Address - City:MATAWAN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-9745
Mailing Address - Country:US
Mailing Address - Phone:609-613-2669
Mailing Address - Fax:
Practice Address - Street 1:159 E KENNEDY BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:NJ
Practice Address - Zip Code:08701-1308
Practice Address - Country:US
Practice Address - Phone:732-860-7505
Practice Address - Fax:732-363-2750
Is Sole Proprietor?:No
Enumeration Date:2018-12-19
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00685100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist