MEDICARE: DR. NANCY N WONG O.D., PH.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	VUT 005839	NY
2	152W00000X	Optometrist	OD0000002339	TN
3	152W00000X	Optometrist	4024	MA

General Provider Information

NPI Number	:	1528032257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NANCY N WONG O.D., PH.D.

Provider Business Mailing Address
First Line	:	100 ALBANY POST RD
Second Line	:	VA HUDSON VALLEY HEALTH CARE SYSTEM - OPTOMETRY SERVICE
City	:	MONTROSE
State	:	NY
Zip	:	10548-1415
Country	:	US
Telephone Number	:	914-737-4400
Fax Number	:	914-788-4373

Provider Business Practice Location Address
First Line	:	100 ALBANY POST RD
Second Line	:	VA HUDSON VALLEY HEALTH CARE SYSTEM - OPTOMETRY SERVICE
City	:	MONTROSE
State	:	NY
Zip	:	10548-1415
Country	:	US
Telephone Number	:	914-737-4400
Fax Number	:	914-788-4373

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

Provider Enumeration Date	:	02/17/2006
Last Update Date	:	07/08/2007

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