Provider Demographics
NPI:1720144173
Name:WONG, SHERRY TAN (OD)
Entity Type:Individual
Prefix:DR
First Name:SHERRY
Middle Name:TAN
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 1:580 LUNALILO HOME RD
Mailing Address - Street 2:#2413
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96825-1733
Mailing Address - Country:US
Mailing Address - Phone:650-580-3093
Mailing Address - Fax:
Practice Address - Street 1:1450 ALA MOANA BLVD STE 3202
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96814-4622
Practice Address - Country:US
Practice Address - Phone:808-468-0100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2022-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI536T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist