Provider Demographics
NPI:1962453423
Name:WONG, JOYCE LUAN (OD)
Entity Type:Individual
Prefix:DR
First Name:JOYCE
Middle Name:LUAN
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 1:7181 WESTWIND DR
Mailing Address - Street 2:STE. D
Mailing Address - City:EL PASO
Mailing Address - State:TX
Mailing Address - Zip Code:79912-1782
Mailing Address - Country:US
Mailing Address - Phone:915-833-1928
Mailing Address - Fax:915-833-1933
Practice Address - Street 1:7181 WESTWIND DR
Practice Address - Street 2:STE. D
Practice Address - City:EL PASO
Practice Address - State:TX
Practice Address - Zip Code:79912-1782
Practice Address - Country:US
Practice Address - Phone:915-833-1928
Practice Address - Fax:915-833-1933
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2016-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX4899TG152W00000X
LA1135152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX093479602Medicaid
TX093479602Medicaid