MEDICARE: ELLEN ONG

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	34486TLG	CA

General Provider Information

NPI Number	:	1639737166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLEN ONG

Provider Business Mailing Address
First Line	:	1720 EL CAMINO REAL
Second Line	:	STE 235
City	:	BURLINGAME
State	:	CA
Zip	:	94010-3213
Country	:	US
Telephone Number	:	650-259-0300
Fax Number	:	650-259-0505

Provider Business Practice Location Address
First Line	:	1720 EL CAMINO REAL STE 235
Second Line	:
City	:	BURLINGAME
State	:	CA
Zip	:	94010-3213
Country	:	US
Telephone Number	:	650-259-0300
Fax Number	:

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

Provider Enumeration Date	:	05/30/2019
Last Update Date	:	12/09/2021

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Directions to “ ELLEN ONG ” Practice Location

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