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General NPI Number Information
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NPI Number | 1104019116
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Entity Type | Organization
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Legal Business Name | PAMELA J. FONG, O.D.
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Dates
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Enumeration Date | 08/22/2007
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Last Update Date | 09/11/2007
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Provider Practice Location Address
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Address Line | 1881 EL CAMINO REAL
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City | BURLINGAME
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State | CA
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Zip | 94010-3220
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Country | US
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Telephone | 650-692-1792
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Fax | 650-692-4245
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Provider Business Mailing Address
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Address Line | 1881 EL CAMINO REAL
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City | BURLINGAME
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State | CA
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Zip | 94010-3220
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Country | US
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Telephone | 650-692-1792
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Fax | 650-692-4245
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Authorized Official
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Title or Position | OWNER
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Name | DR. PAMELA J. FONG
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Credential | O.D.
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Telephone | 650-692-1792
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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 | 7461T
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License Number State | CA
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