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General NPI Number Information
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NPI Number | 1265473789
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Entity Type | Individual
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Provider Name | JONATHAN T WONG O.D.
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Gender | Male
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Dates
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Enumeration Date | 06/08/2006
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Last Update Date | 02/10/2014
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Provider Practice Location Address
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Address Line | 12420 FM 1960 RD W
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City | HOUSTON
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State | TX
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Zip | 77065-4809
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Country | US
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Telephone | 832-237-1688
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Fax | 832-237-3905
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Provider Business Mailing Address
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Address Line | 12420 FM 1960 RD W
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City | HOUSTON
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State | TX
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Zip | 77065-4809
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Country | US
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Telephone | 832-237-1688
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Fax | 832-237-3905
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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 | 5607TG
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License Number State | TX
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