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General NPI Number Information
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NPI Number | 1023170073
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Entity Type | Individual
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Provider Name | IVAN WONG O.D.
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Gender | Male
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 10/22/2007
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Provider Practice Location Address
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Address Line | 7 BACKUS AVE STE 250
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City | DANBURY
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State | CT
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Zip | 06810-7493
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Country | US
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Telephone | 203-743-9897
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Fax | 203-743-6419
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Provider Business Mailing Address
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Address Line | 7 BACKUS AVE STE 250
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City | DANBURY
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State | CT
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Zip | 06810-7493
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Country | US
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Telephone | 203-743-9897
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Fax | 203-743-6419
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | CT002529
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License Number State | CT
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Taxonomy #2
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Taxonomy Code | 152WC0802X
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Taxonomy Name | Corneal and Contact Management Optometrist
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License Number | CT002529
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License Number State | CT
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Taxonomy #3
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Taxonomy Code | 152WP0200X
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Taxonomy Name | Pediatric Optometrist
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License Number | CT2529
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License Number State | CT
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Taxonomy #4
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Taxonomy Code | 152WX0102X
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Taxonomy Name | Occupational Vision Optometrist
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License Number | CT2529
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License Number State | CT
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Taxonomy #5
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Taxonomy Code | 152WX0102X
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Taxonomy Name | Occupational Vision Optometrist
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License Number | CT002529
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License Number State | CT
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