Healthcare Provider Details

I. General information

NPI: 1356915979
Provider Name (Legal Business Name): ASHLEY WONG, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2021
Last Update Date: 05/18/2021
Certification Date: 04/22/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3272 BENNETT CREEK AVE UNIT B
FREDERICK MD
21704
US

IV. Provider business mailing address

9308 BISHOPGATE DR
FREDERICK MD
21704-7356
US

V. Phone/Fax

Practice location:
  • Phone: 301-732-7988
  • Fax: 301-732-7881
Mailing address:
  • Phone: 301-385-2840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152WP0200X
TaxonomyPediatric Optometrist
License Number
License Number State

VIII. Authorized Official

Name: DR. ASHLEY WONG
Title or Position: PEDIATRIC OPTOMETRIST
Credential: OD
Phone: 301-385-2840