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General NPI Number Information
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NPI Number | 1750583928
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Entity Type | Individual
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Provider Name | SAI HO WONG O.D.
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Gender | Male
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Dates
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Enumeration Date | 06/01/2007
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Last Update Date | 10/11/2013
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Provider Practice Location Address
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Address Line | 17497 MAIN ST
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City | HESPERIA
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State | CA
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Zip | 92345-6268
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Country | US
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Telephone | 760-948-3345
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Fax | 760-948-3346
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Provider Business Mailing Address
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Address Line | 11253 GREENWOOD WAY
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City | ONTARIO
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State | CA
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Zip | 91762-5230
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Country | US
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Telephone | 626-380-5664
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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 | 12720TPA
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License Number State | CA
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