Physician Compare National (NPI:1306971429)

HEALTHCARE PROVIDER: CAROLYN MARIE WONG O.D.

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1306971429
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	7113053141
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20100330000338
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	WONG
	Individual professional last name
Provider First Name	CAROLYN
	Individual professional first name
Provider Middle Name	MARIE
	Individual professional middle name
Provider Gender	F
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	SOUTHERN CALIFORNIA COLLEGE OF OPTOMETRY
	Individual professional's medical school
Graduation Year	1982
	Individual professional's medical school graduation year
Primary Specialty	OPTOMETRY
	Primary medical specialty reported by the individual professional in the selected enrollment

Practice Information
Line 1 Street Address	11540 SANTA MONICA BLVD
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 202
	Group Practice or individual's line 2 address
City	LOS ANGELES
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	900257905
	Group Practice or individual's zip code (9 digits when available)
Phone Number	3104735464
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y