MEDICARE: JACQUELINE W WONG MD

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	207W00000X	Ophthalmology Physician	MD00039827	WA

General Provider Information

NPI Number	:	1760479323
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELINE W WONG MD

Provider Business Mailing Address
First Line	:	945 HILDEBRAND LN NE
Second Line	:	SUITE 235
City	:	BAINBRIDGE ISLAND
State	:	WA
Zip	:	98110-2877
Country	:	US
Telephone Number	:	360-621-9970
Fax Number	:	206-257-0983

Provider Business Practice Location Address
First Line	:	945 HILDEBRAND LN NE
Second Line	:	SUITE 235
City	:	BAINBRIDGE ISLAND
State	:	WA
Zip	:	98110-2877
Country	:	US
Telephone Number	:	360-621-9970
Fax Number	:	206-257-0983

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

Provider Enumeration Date	:	09/29/2005
Last Update Date	:	07/31/2013

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