MEDICARE: DR. CARSON KATSUN 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	TUV007444-1	NY

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1639308885
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CARSON KATSUN WONG O.D.

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

Provider Business Practice Location Address
First Line	:	44 SYLVAN AVE
Second Line	:	SUITE 1B
City	:	ENGLEWOOD CLIFFS
State	:	NJ
Zip	:	07632-2417
Country	:	US
Telephone Number	:	201-592-1982
Fax Number	:

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

Provider Enumeration Date	:	07/09/2009
Last Update Date	:	01/03/2013

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