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General NPI Number Information
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NPI Number | 1831721778
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Entity Type | Organization
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Legal Business Name | JAMIE WONG OD INC
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Dates
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Enumeration Date | 02/09/2020
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Last Update Date | 02/09/2020
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Provider Practice Location Address
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Address Line | 1895 MOWRY AVE STE 117
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City | FREMONT
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State | CA
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Zip | 94538-1736
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Country | US
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Telephone | 510-797-8770
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Fax |
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Provider Business Mailing Address
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Address Line | 5372 PORT SAILWOOD DR
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City | NEWARK
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State | CA
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Zip | 94560-2667
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Country | US
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Telephone | 510-797-8770
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Fax | 510-797-3926
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Authorized Official
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Title or Position | OWNER
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Name | JAMIE WONG
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Credential | OD
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Telephone | 510-797-8770
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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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