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General NPI Number Information
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NPI Number | 1861931750
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Entity Type | Individual
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Provider Name | JULIE WONG O.D.
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Gender | Female
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Dates
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Enumeration Date | 02/13/2017
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Last Update Date | 09/21/2023
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Provider Practice Location Address
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Address Line | 24022 CALLE DE LA PLATA STE 300
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City | LAGUNA HILLS
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State | CA
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Zip | 92653-3629
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Country | US
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Telephone | 949-284-7487
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Fax | 949-595-4459
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Provider Business Mailing Address
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Address Line | 625 THE CITY DRIVE SUITE 100
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City | ORANGE
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State | CA
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Zip | 92868
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Country | US
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Telephone | 714-703-8077
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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 | 11239
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License Number State | CA
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