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General NPI Number Information
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NPI Number | 1457773822
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Entity Type | Organization
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Legal Business Name | DORIS H WONG OPTOMETRIC CORPORATION
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Dates
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Enumeration Date | 01/20/2014
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Last Update Date | 03/27/2015
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Provider Practice Location Address
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Address Line | 5580 SPRINGDALE AVE STE E
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City | PLEASANTON
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State | CA
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Zip | 94588-3707
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Country | US
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Telephone | 925-463-3100
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Fax | 925-463-3101
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Provider Business Mailing Address
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Address Line | 5580 SPRINGDALE AVE STE E
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City | PLEASANTON
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State | CA
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Zip | 94588-3707
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Country | US
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Telephone | 925-463-3100
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Fax | 925-463-3101
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Authorized Official
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Title or Position | PRESIDENT
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Name | DORIS H WONG
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Credential | OD
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Telephone | 808-721-7167
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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 | 13121T
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License Number State | CA
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