Provider Demographics
NPI:1891934089
Name:FONG, GRACE LING-EN (OD)
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:LING-EN
Last Name:FONG
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 1:4427 HIGHWAY 6 S
Mailing Address - Street 2:STE. L
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478
Mailing Address - Country:US
Mailing Address - Phone:281-313-1810
Mailing Address - Fax:281-313-1803
Practice Address - Street 1:4427 HWY 6 S
Practice Address - Street 2:STE. L
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478
Practice Address - Country:US
Practice Address - Phone:281-313-1810
Practice Address - Fax:281-313-1803
Is Sole Proprietor?:No
Enumeration Date:2009-02-11
Last Update Date:2009-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX06125TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
V01096Medicare UPIN
8C2025Medicare PIN