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General NPI Number Information
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NPI Number | 1902958309
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Entity Type | Individual
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Provider Name | WILLA WAI-LAI WONG O.D.
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Gender | Female
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Dates
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Enumeration Date | 01/17/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 616 W HUNTINGTON DR
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City | MONROVIA
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State | CA
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Zip | 91016-3206
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Country | US
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Telephone | 626-303-5125
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Fax | 626-358-7448
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Provider Business Mailing Address
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Address Line | 3320 WOOD TER
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City | LOS ANGELES
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State | CA
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Zip | 90027-2205
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Country | US
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Telephone | 323-661-7860
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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 | 10567T
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License Number State | CA
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