=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548501315
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | MAUREEN HONG O.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/04/2013
-----------------------------------------------------
Last Update Date | 05/05/2016
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 48 W ROMIE LN
-----------------------------------------------------
City | SALINAS
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93901-2317
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-424-0834
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5047 SUNSET VISTA DR
-----------------------------------------------------
City | SEASIDE
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 93955-6522
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 831-424-0834
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | OPT 12283 TPL
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------