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General NPI Number Information
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NPI Number | 1386283935
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Entity Type | Organization
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Legal Business Name | ELENA WONG O.D., INC.
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Dates
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Enumeration Date | 12/31/2019
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Last Update Date | 12/31/2019
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Provider Practice Location Address
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Address Line | 1019 ALAMEDA DE LAS PULGAS
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City | BELMONT
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State | CA
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Zip | 94002-3507
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Country | US
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Telephone | 650-594-1019
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Fax |
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Provider Business Mailing Address
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Address Line | 337 ESTRELLA WAY
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City | SAN MATEO
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State | CA
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Zip | 94403-2940
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Country | US
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Telephone | 510-508-5233
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | ELENA WONG
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Credential | OD
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Telephone | 510-508-5233
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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 |
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License Number State |
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