Healthcare Provider Details

I. General information

NPI: 1508274416
Provider Name (Legal Business Name): VICTOR J WONG O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2014
Last Update Date: 01/03/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4501 SAND CREEK RD
ANTIOCH CA
94531-8687
US

IV. Provider business mailing address

395 CIVIC DR SUITE G
PLEASANT HILL CA
94523-1979
US

V. Phone/Fax

Practice location:
  • Phone: 925-813-3280
  • Fax: 925-813-3341
Mailing address:
  • Phone: 925-676-8365
  • Fax: 925-676-3382

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT 15042 TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: