Healthcare Provider Details

I. General information

NPI: 1528032257
Provider Name (Legal Business Name): NANCY N WONG O.D., PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 02/17/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ALBANY POST RD VA HUDSON VALLEY HEALTH CARE SYSTEM - OPTOMETRY SERVICE
MONTROSE NY
10548-1415
US

IV. Provider business mailing address

100 ALBANY POST RD VA HUDSON VALLEY HEALTH CARE SYSTEM - OPTOMETRY SERVICE
MONTROSE NY
10548-1415
US

V. Phone/Fax

Practice location:
  • Phone: 914-737-4400
  • Fax: 914-788-4373
Mailing address:
  • Phone: 914-737-4400
  • Fax: 914-788-4373

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberVUT 005839
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License NumberOD0000002339
License Number StateTN
# 3
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number4024
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: