Individual
DR. ALICIA X WONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
OD
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
046011357
IL
152WV0400X
Vision Therapy Optometrist
Primary
046011357
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
046011357
ILLINOIS LICENSE
IL
Enumeration date
07/22/2018
Last updated
10/26/2023
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