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Individual
SELENA CONSTANCE WONG
Active
Individual
SELENA CONSTANCE WONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
33549
CA
152W00000X
Optometrist
OEG002662
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
102733683
—
PA
05
—
1164787628
—
CA
01
—
OEG002662
LICENSE
PA
Enumeration date
07/11/2012
Last updated
06/12/2024
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