Healthcare Provider Details

I. General information

NPI: 1598933475
Provider Name (Legal Business Name): LISA JUN-PEI WONG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/13/2008
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2308 FOSSIL TRACE DR
GOLDEN CO
80401-6149
US

IV. Provider business mailing address

2308 FOSSIL TRACE DR
GOLDEN CO
80401-6149
US

V. Phone/Fax

Practice location:
  • Phone: 720-466-3937
  • Fax:
Mailing address:
  • Phone: 720-466-3937
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License NumberME177707
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number49920
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: