MEDICARE: DR. JUDY 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	5472T	TX

General Provider Information

NPI Number	:	1861531931
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JUDY WONG O.D.

Provider Business Mailing Address
First Line	:	9109 WARM SPRINGS CIR
Second Line	:
City	:	PLANO
State	:	TX
Zip	:	75024-7058
Country	:	US
Telephone Number	:	469-467-8511
Fax Number	:	469-467-8512

Provider Business Practice Location Address
First Line	:	6000 COIT RD
Second Line	:	SUITE 100
City	:	PLANO
State	:	TX
Zip	:	75023-5903
Country	:	US
Telephone Number	:	469-467-8511
Fax Number	:

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

Provider Enumeration Date	:	02/06/2007
Last Update Date	:	07/08/2007

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Directions to “ DR. JUDY WONG O.D.” Practice Location

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