Individual
DR. CAROLYN MARIE WONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
11540 SANTA MONICA BLVD, SUITE 202, LOS ANGELES, CA 90025-7905
(310) 473-5464
(310) 473-2536
Mailing address
11540 SANTA MONICA BLVD, SUITE 202, LOS ANGELES, CA 90025-7905
(310) 473-5464
(310) 473-2536
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
7450T
CA
152W00000X
Optometrist
Primary
OP7450
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
SD0074500
—
CA
Enumeration date
02/22/2007
Last updated
02/05/2020
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