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General NPI Number Information
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NPI Number | 1710137708
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Entity Type | Organization
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Legal Business Name | DR. CAROLYN WONG
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Dates
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Enumeration Date | 09/25/2008
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Last Update Date | 07/31/2025
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Provider Practice Location Address
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Address Line | 11540 SANTA MONICA BLVD SUITE 202
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City | LOS ANGELES
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State | CA
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Zip | 90025-7905
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Country | US
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Telephone | 310-473-5464
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Fax |
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Provider Business Mailing Address
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Address Line | 11540 SANTA MONICA BLVD SUITE 202
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City | LOS ANGELES
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State | CA
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Zip | 90025-7905
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Country | US
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Telephone | 310-473-5464
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Fax |
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Authorized Official
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Title or Position | OWNER/OPTOMETRIST
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Name | CAROLYN M WONG
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Credential | O.D.
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Telephone | 310-473-5464
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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 | 7450T
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License Number State | CA
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