Provider Demographics
NPI:1720066731
Name:WONG, LAWRENCE SHAWN (MD)
Entity Type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:SHAWN
Last Name:WONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:L.
Other - Middle Name:SHAWN
Other - Last Name:WONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2901 NORTH SHIELDS DR.
Mailing Address - Street 2:SUITE 100
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78727-3128
Mailing Address - Country:US
Mailing Address - Phone:512-345-5030
Mailing Address - Fax:512-345-5048
Practice Address - Street 1:2901 NORTH SHIELDS DR.
Practice Address - Street 2:SUITE 100
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78727
Practice Address - Country:US
Practice Address - Phone:512-345-5030
Practice Address - Fax:512-345-5048
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-09
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXH9281207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX116911202Medicaid
TXF03855Medicare UPIN