Provider Demographics
NPI:1205902178
Name:WONG, WAI-LING (OD)
Entity type:Individual
Prefix:DR
First Name:WAI-LING
Middle Name:
Last Name:WONG
Suffix:
Gender:
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:308 N LA CADENA DR
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-2946
Mailing Address - Country:US
Mailing Address - Phone:909-321-4700
Mailing Address - Fax:909-824-2887
Practice Address - Street 1:308 N LA CADENA DR
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-2946
Practice Address - Country:US
Practice Address - Phone:909-321-4700
Practice Address - Fax:909-824-2887
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2025-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12029TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
04798NE6Medicare ID - Type Unspecified
U85331Medicare UPIN