Healthcare Provider Details

I. General information

NPI: 1114078169
Provider Name (Legal Business Name): DR. WONG & ASSOCIATES, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2007
Last Update Date: 08/29/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 BACKUS AVE STE 250
DANBURY CT
06810-7493
US

IV. Provider business mailing address

7 BACKUS AVE STE 250
DANBURY CT
06810-7493
US

V. Phone/Fax

Practice location:
  • Phone: 203-743-9897
  • Fax: 203-743-6419
Mailing address:
  • Phone: 203-743-9897
  • Fax: 203-743-6419

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberCT002529
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License NumberCT002529
License Number StateCT

VIII. Authorized Official

Name: DR. IVAN WONG
Title or Position: PRESIDENT
Credential: O.D.
Phone: 203-743-9897