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General NPI Number Information
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NPI Number | 1164787628
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Entity Type | Individual
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Provider Name | SELENA CONSTANCE WONG OD
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Gender | Female
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Dates
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Enumeration Date | 07/11/2012
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Last Update Date | 06/12/2024
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Provider Practice Location Address
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Address Line | 855 W FOOTHILL BLVD
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City | MONROVIA
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State | CA
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Zip | 91016-1938
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Country | US
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Telephone | 626-358-1080
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Fax | 626-358-0548
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Provider Business Mailing Address
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Address Line | 14726 RAMONA AVE STE 203
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City | CHINO
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State | CA
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Zip | 91710-5730
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Country | US
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Telephone | 626-305-9100
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Fax | 626-305-0152
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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 | OEG002662
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 33549
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License Number State | CA
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