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General NPI Number Information
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NPI Number | 1871895805
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Entity Type | Individual
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Provider Name | SANDRA WAI WONG O.D.
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Gender | Female
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Dates
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Enumeration Date | 11/23/2010
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Last Update Date | 11/23/2010
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Provider Practice Location Address
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Address Line | 3275 TITTABAWASSEE RD
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City | SAGINAW
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State | MI
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Zip | 48604-9436
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Country | US
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Telephone | 989-399-3477
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Fax |
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Provider Business Mailing Address
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Address Line | 296 GRAYSON HWY
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City | LAWRENCEVILLE
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State | GA
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Zip | 30046-5737
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Country | US
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Telephone | 800-992-2134
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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 | 4901004612
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License Number State | MI
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