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General NPI Number Information
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NPI Number | 1386955565
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Entity Type | Individual
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Provider Name | GENE WONG O.D.
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Gender | Male
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Dates
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Enumeration Date | 06/23/2010
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Last Update Date | 10/23/2022
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Provider Practice Location Address
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Address Line | 1316 E HWY 377
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City | GRANBURY
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State | TX
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Zip | 76048-2548
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Country | US
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Telephone | 682-498-8750
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Fax |
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Provider Business Mailing Address
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Address Line | 4911 W SAMPLE RD APT 302
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City | COCONUT CREEK
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State | FL
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Zip | 33073-3422
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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 | OPC5006
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License Number State | FL
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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 | 0618001953
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License Number State | VA
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Taxonomy #3
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 7686T
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License Number State | TX
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