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NPI Code Detail

MEDICARE: DR. DEREK T TONG O.D.

MEDICARE: DR. DEREK T TONG 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
1152W00000XOptometrist12008TCA
2152WV0400XVision Therapy Optometrist12008TCA

General Provider Information

NPI Number : 1972574614
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DEREK T TONG O.D.
Provider Business Mailing Address
First Line : 2700 E FOOTHILL BLVD
Second Line : STE 207
City : PASADENA
State : CA
Zip : 91107-7100
Country : US
Telephone Number : 626-578-9685
Fax Number : 626-578-9737
Provider Business Practice Location Address
First Line : 2700 E FOOTHILL BLVD
Second Line : STE 207
City : PASADENA
State : CA
Zip : 91107-7100
Country : US
Telephone Number : 626-578-9685
Fax Number : 626-578-9737
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/31/2006
Last Update Date : 09/01/2016

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Directions to “ DR. DEREK T TONG O.D.” Practice Location

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