Healthcare Provider Details

I. General information

NPI: 1497159552
Provider Name (Legal Business Name): SHARON ANN WONG O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/20/2014
Last Update Date: 02/25/2020
Certification Date: 02/25/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3440 LOMITA BLVD STE 100
TORRANCE CA
90505-4810
US

IV. Provider business mailing address

100 E CALIFORNIA BLVD
PASADENA CA
91105-3205
US

V. Phone/Fax

Practice location:
  • Phone: 562-317-3893
  • Fax: 562-206-2507
Mailing address:
  • Phone: 800-898-2020
  • Fax: 626-577-2100

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOPT15137TLG
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: