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General NPI Number Information
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NPI Number | 1366823221
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Entity Type | Individual
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Provider Name | VERISSA LAM FONG O.D.
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Gender | Female
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Dates
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Enumeration Date | 06/16/2015
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Last Update Date | 05/04/2022
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Provider Practice Location Address
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Address Line | 3241 S MICHIGAN AVE #72
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City | CHICAGO
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State | IL
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Zip | 60616-4201
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Country | US
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Telephone | 415-321-9988
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Fax |
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Provider Business Mailing Address
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Address Line | 100 BATTERY ST
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City | SAN FRANCISCO
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State | CA
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Zip | 94111-4903
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Country | US
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Telephone |
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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 | 15279
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License Number State | CA
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