MEDICARE: DR. ALEXANDER WONG O.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	SD0104450	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1225021017
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALEXANDER WONG O.D.

Provider Business Mailing Address
First Line	:	1410 BLACKSTONE RD
Second Line	:
City	:	SAN MARINO
State	:	CA
Zip	:	91108-2721
Country	:	US
Telephone Number	:	909-825-2020
Fax Number	:	909-825-0152

Provider Business Practice Location Address
First Line	:	555 E PACIFIC COAST HWY
Second Line	:	STE 101
City	:	LONG BEACH
State	:	CA
Zip	:	90806-5579
Country	:	US
Telephone Number	:	562-494-9958
Fax Number	:	562-494-0950

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	04/29/2025

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