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General NPI Number Information
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NPI Number | 1366535031
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Entity Type | Individual
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Provider Name | ANNA WONG O.D.
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Gender | Female
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Dates
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Enumeration Date | 10/02/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1601 SW ARCHER ROAD
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City | GAINESVILLE
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State | FL
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Zip | 32608
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Country | US
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Telephone | 352-376-1611
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Fax | 352-271-4543
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Provider Business Mailing Address
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Address Line | 8632 SW 76TH PLACE
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City | GAINESVILLE
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State | FL
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Zip | 32608
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Country | US
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Telephone | 352-692-4790
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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 | OPC 3407
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License Number State | FL
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