MEDICARE: MATTHEW CHARLES FONG OD

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	35293	CA

General Provider Information

NPI Number	:	1396466033
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MATTHEW CHARLES FONG OD

Provider Business Mailing Address
First Line	:	3956 J ST STE 4
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95819-3625
Country	:	US
Telephone Number	:	916-739-6260
Fax Number	:	916-739-0168

Provider Business Practice Location Address
First Line	:	3956 J ST STE 4
Second Line	:
City	:	SACRAMENTO
State	:	CA
Zip	:	95819-3625
Country	:	US
Telephone Number	:	916-739-6260
Fax Number	:	916-739-0168

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

Provider Enumeration Date	:	09/12/2022
Last Update Date	:	09/12/2022

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