MEDICARE: DR. JENNIFER H ONG 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	OPT10520T	CA

General Provider Information

NPI Number	:	1700878055
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JENNIFER H ONG O.D.

Provider Business Mailing Address
First Line	:	2223 SANTA CLARA AVE
Second Line	:	SUITE A
City	:	ALAMEDA
State	:	CA
Zip	:	94501-4469
Country	:	US
Telephone Number	:	510-521-0551
Fax Number	:	510-864-0100

Provider Business Practice Location Address
First Line	:	2223 SANTA CLARA AVE
Second Line	:	SUITE A
City	:	ALAMEDA
State	:	CA
Zip	:	94501-4469
Country	:	US
Telephone Number	:	510-521-0551
Fax Number	:	510-864-0100

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

Provider Enumeration Date	:	08/22/2005
Last Update Date	:	01/07/2015

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