Provider Demographics
NPI:1912010463
Name:DONG, HAN W (OD)
Entity Type:Individual
Prefix:DR
First Name:HAN
Middle Name:W
Last Name:DONG
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 1:22 ISABELLA ST
Mailing Address - Street 2:
Mailing Address - City:QUINCY
Mailing Address - State:MA
Mailing Address - Zip Code:02169-7515
Mailing Address - Country:US
Mailing Address - Phone:781-871-3970
Mailing Address - Fax:617-471-4878
Practice Address - Street 1:22 ISABELLA ST
Practice Address - Street 2:
Practice Address - City:QUINCY
Practice Address - State:MA
Practice Address - Zip Code:02169-7515
Practice Address - Country:US
Practice Address - Phone:781-871-3970
Practice Address - Fax:617-471-4878
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA2247152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0304395Medicaid
MA0304395Medicaid
MA156158Medicare ID - Type Unspecified