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General NPI Number Information
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NPI Number | 1598323602
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Entity Type | Organization
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Legal Business Name | JUSTIN WONG OD AN OPTOMETRIC CORPORATION
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Dates
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Enumeration Date | 06/04/2019
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Last Update Date | 06/04/2019
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Provider Practice Location Address
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Address Line | 250 E YALE LOOP STE G
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City | IRVINE
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State | CA
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Zip | 92604-4697
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Country | US
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Telephone | 949-333-7504
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Fax | 949-333-7503
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Provider Business Mailing Address
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Address Line | 474 MONROE
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City | IRVINE
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State | CA
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Zip | 92620-3656
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Country | US
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Telephone | 714-928-3612
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Fax |
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Authorized Official
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Title or Position | OPTOMETRIST
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Name | DR. JUSTIN WYMAN WONG
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Credential | OD
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Telephone | 714-928-3612
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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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