Provider Demographics
NPI:1336395714
Name:WONG, SONMI P (OD)
Entity Type:Individual
Prefix:
First Name:SONMI
Middle Name:P
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 1:346 ROUTE 25A STE 58
Mailing Address - Street 2:
Mailing Address - City:ROCKY POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11778-8425
Mailing Address - Country:US
Mailing Address - Phone:631-744-6800
Mailing Address - Fax:
Practice Address - Street 1:346 ROUTE 25A STE 58
Practice Address - Street 2:
Practice Address - City:ROCKY POINT
Practice Address - State:NY
Practice Address - Zip Code:11778-8425
Practice Address - Country:US
Practice Address - Phone:631-744-6800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-08-18
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV006277-1152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist