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General NPI Number Information
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NPI Number | 1679050009
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Entity Type | Individual
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Provider Name | JIANLIANG TONG OD
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Gender | Male
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Dates
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Enumeration Date | 07/28/2018
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Last Update Date | 07/28/2018
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Provider Practice Location Address
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Address Line | 3350 BUFORD DR
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City | BUFORD
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State | GA
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Zip | 30519-4991
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Country | US
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Telephone | 713-703-7387
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Fax |
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Provider Business Mailing Address
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Address Line | 1523 RIVER CHASE TRL
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City | DULUTH
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State | GA
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Zip | 30096-5394
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Country | US
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Telephone | 713-703-7387
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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 | OPT003119
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License Number State | GA
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