Individual
SHANNON M WONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
11901 JOLLYVILLE RD, AUSTIN, TX 78759-2303
(572) 250-2020
(572) 250-2612
Mailing address
11901 JOLLYVILLE RD, AUSTIN, TX 78759-2303
(512) 250-2020
(512) 250-2612
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
J6050
TX
207W00000X
Ophthalmology Physician
Primary
J6050
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
038163401
—
TX
Enumeration date
07/08/2005
Last updated
09/08/2020
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