MEDICARE: DR. LAWRENCE SHAWN WONG M.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	207W00000X	Ophthalmology Physician	H9281	TX

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	:	1720066731
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LAWRENCE SHAWN WONG M.D.

Provider Business Mailing Address
First Line	:	2901 NORTH SHIELDS DR.
Second Line	:	SUITE 100
City	:	AUSTIN
State	:	TX
Zip	:	78727-3128
Country	:	US
Telephone Number	:	512-345-5030
Fax Number	:	512-345-5048

Provider Business Practice Location Address
First Line	:	2901 NORTH SHIELDS DR.
Second Line	:	SUITE 100
City	:	AUSTIN
State	:	TX
Zip	:	78727
Country	:	US
Telephone Number	:	512-345-5030
Fax Number	:	512-345-5048

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

Provider Enumeration Date	:	01/09/2006
Last Update Date	:	10/15/2019

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