Individual
DR. GENE WONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
O.D.
Contact information
Practice address
1316 E HWY 377, GRANBURY, TX 76048-2548
(682) 498-8750
Mailing address
4911 W SAMPLE RD APT 302, COCONUT CREEK, FL 33073-3422
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
0618001953
VA
152W00000X
Optometrist
Primary
7686T
TX
152W00000X
Optometrist
OPC5006
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
013636600
MEDICAID
FL
05
—
287979301
—
TX
Enumeration date
06/23/2010
Last updated
10/23/2022
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