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NPI Code Detail

MEDICARE: SHU TZU WONG PHD

MEDICARE: SHU TZU WONG PHD
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
1152WL0500XLow Vision Rehabilitation Optometrist4410KS

General Provider Information

NPI Number : 1699768895
Entity Type Code : Individual
Provider Name (Legal Business Name) : SHU TZU WONG PHD
Provider Business Mailing Address
First Line : 2301 S WATER ST
Second Line :
City : WICHITA
State : KS
Zip : 67213-4819
Country : US
Telephone Number : 316-682-4646
Fax Number : 316-263-4116
Provider Business Practice Location Address
First Line : 2301 S WATER ST
Second Line :
City : WICHITA
State : KS
Zip : 67213-4819
Country : US
Telephone Number : 316-682-4646
Fax Number : 316-263-4116
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/24/2005
Last Update Date : 07/08/2007

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Directions to “ SHU TZU WONG PHD” Practice Location

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