Provider Demographics
NPI:1255535159
Name:WONG, DAVID (OD)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:WONG
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 1:8450 LA PALMA AVE
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90620-3210
Mailing Address - Country:US
Mailing Address - Phone:626-222-1243
Mailing Address - Fax:714-527-5873
Practice Address - Street 1:8450 LA PALMA AVE
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90620-3210
Practice Address - Country:US
Practice Address - Phone:714-527-9236
Practice Address - Fax:714-527-5873
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-13
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13211152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist