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General NPI Number Information
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NPI Number | 1730416611
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Entity Type | Organization
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Legal Business Name | CARSON K. WONG, O.D.
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Dates
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Enumeration Date | 11/12/2009
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Last Update Date | 01/16/2010
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Provider Practice Location Address
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Address Line | 13620 38TH AVE STE 5B
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City | FLUSHING
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State | NY
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Zip | 11354-4264
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Country | US
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Telephone | 646-355-8393
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Fax |
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Provider Business Mailing Address
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Address Line | 13620 38TH AVE STE 5B
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City | FLUSHING
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State | NY
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Zip | 11354-4264
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | DR. CARSON K WONG
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Credential |
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Telephone | 646-355-8393
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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 | TUV007444
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License Number State | NY
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