Basic Information
| Provider Information | |||||||||
| NPI: | 1871895805 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | WONG | ||||||||
| FirstName: | SANDRA | ||||||||
| MiddleName: | WAI | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | O.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 296 GRAYSON HWY | ||||||||
| Address2: | |||||||||
| City: | LAWRENCEVILLE | ||||||||
| State: | GA | ||||||||
| PostalCode: | 300465737 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8009922134 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3275 TITTABAWASSEE RD | ||||||||
| Address2: | |||||||||
| City: | SAGINAW | ||||||||
| State: | MI | ||||||||
| PostalCode: | 486049436 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9893993477 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2010 | ||||||||
| LastUpdateDate: | 11/23/2010 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 152W00000X | 4901004612 | MI | Y | Eye and Vision Services Providers | Optometrist |
No ID Information.