Individual
VERNON WONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
25229 PINTO LN, CUSTER, SD 57730-7218
(605) 673-5663
Mailing address
25229 PINTO LN, CUSTER, SD 57730-7218
(605) 673-5663
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1236
NE
Other
Enumeration date
03/06/2007
Last updated
07/08/2007
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