Provider Demographics
NPI:1821132143
Name:ONG, WINSON (OD)
Entity Type:Individual
Prefix:
First Name:WINSON
Middle Name:
Last Name:ONG
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 1:3840 BALFOUR RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BRENTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:94513-1641
Mailing Address - Country:US
Mailing Address - Phone:925-513-0323
Mailing Address - Fax:
Practice Address - Street 1:3840 BALFOUR RD
Practice Address - Street 2:SUITE A
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-1641
Practice Address - Country:US
Practice Address - Phone:925-513-0323
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-19
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11938T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0119381Medicaid
CAU92137Medicare UPIN
CASD0119381Medicaid