Provider Demographics
NPI:1861454639
Name:WONG, TRACEY (OD)
Entity Type:Individual
Prefix:DR
First Name:TRACEY
Middle Name:
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 1:22762 WESTHEIMER PKWY STE 405
Mailing Address - Street 2:
Mailing Address - City:KATY
Mailing Address - State:TX
Mailing Address - Zip Code:77450-8825
Mailing Address - Country:US
Mailing Address - Phone:281-395-2010
Mailing Address - Fax:
Practice Address - Street 1:22762 WESTHEIMER PKWY STE 405
Practice Address - Street 2:
Practice Address - City:KATY
Practice Address - State:TX
Practice Address - Zip Code:77450-8825
Practice Address - Country:US
Practice Address - Phone:281-395-2010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-05
Last Update Date:2010-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6819TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8F5654Medicare PIN