Provider Demographics
NPI:1972574614
Name:TONG, DEREK T (OD)
Entity Type:Individual
Prefix:DR
First Name:DEREK
Middle Name:T
Last Name:TONG
Suffix:
Gender:M
Credentials:OD
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Mailing Address - Street 1:2700 E FOOTHILL BLVD
Mailing Address - Street 2:STE 207
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91107-7100
Mailing Address - Country:US
Mailing Address - Phone:626-578-9685
Mailing Address - Fax:626-578-9737
Practice Address - Street 1:2700 E FOOTHILL BLVD
Practice Address - Street 2:STE 207
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-7100
Practice Address - Country:US
Practice Address - Phone:626-578-9685
Practice Address - Fax:626-578-9737
Is Sole Proprietor?:No
Enumeration Date:2006-01-31
Last Update Date:2016-09-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA12008T152W00000X, 152WV0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WV0400XEye and Vision Services ProvidersOptometristVision Therapy
No152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA77109Medicare UPIN