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General NPI Number Information
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NPI Number | 1336523299
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Entity Type | Individual
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Provider Name | MAGGIE WONG O.D.
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Gender | Female
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Dates
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Enumeration Date | 07/10/2015
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Last Update Date | 04/17/2020
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Provider Practice Location Address
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Address Line | 8246 LAGUNA BLVD STE 300
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City | ELK GROVE
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State | CA
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Zip | 95758-7972
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Country | US
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Telephone | 916-684-6688
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Fax |
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Provider Business Mailing Address
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Address Line | 8246 LAGUNA BLVD STE 300
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City | ELK GROVE
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State | CA
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Zip | 95758-7972
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Country | US
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Telephone | 916-684-6688
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Fax |
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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 | 3621AT
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License Number State | OR
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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 | 33874TLG
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License Number State | CA
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