Provider Demographics
NPI:1750583928
Name:WONG, SAI HO (OD)
Entity type:Individual
Prefix:
First Name:SAI
Middle Name:HO
Last Name:WONG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Mailing Address - Street 1:11253 GREENWOOD WAY
Mailing Address - Street 2:
Mailing Address - City:ONTARIO
Mailing Address - State:CA
Mailing Address - Zip Code:91762-5230
Mailing Address - Country:US
Mailing Address - Phone:626-380-5664
Mailing Address - Fax:
Practice Address - Street 1:17497 MAIN ST
Practice Address - Street 2:
Practice Address - City:HESPERIA
Practice Address - State:CA
Practice Address - Zip Code:92345-6268
Practice Address - Country:US
Practice Address - Phone:760-948-3345
Practice Address - Fax:760-948-3346
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12720TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist