Healthcare Provider Details

I. General information

NPI: 1205902178
Provider Name (Legal Business Name): WAI-LING WONG O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/24/2006
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

290 N WAYTE LN STE 1600
FRESNO CA
93701-2124
US

IV. Provider business mailing address

290 N WAYTE LN STE 1600
FRESNO CA
93701-2124
US

V. Phone/Fax

Practice location:
  • Phone: 800-492-4227
  • Fax: 833-438-5189
Mailing address:
  • Phone: 800-492-4227
  • Fax: 833-438-5189

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number12029TPG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: