MEDICARE: DR. JIYUN WONG O.D

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	TUV008018-1	NY
2	152W00000X	Optometrist	27OA00664600	NJ

General Provider Information

NPI Number	:	1033559745
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JIYUN WONG O.D

Provider Business Mailing Address
First Line	:	44 SYLVAN AVE STE 1B
Second Line	:
City	:	ENGLEWOOD CLIFFS
State	:	NJ
Zip	:	07632-2417
Country	:	US
Telephone Number	:	646-247-9047
Fax Number	:

Provider Business Practice Location Address
First Line	:	44 SYLVAN AVE STE 1B
Second Line	:
City	:	ENGLEWOOD CLIFFS
State	:	NJ
Zip	:	07632-2417
Country	:	US
Telephone Number	:	201-591-1982
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2013
Last Update Date	:	08/17/2021

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