Individual
DIANNE LEE WONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
O.D.
Contact information
Practice address
901 E ST, STE 285, SAN RAFAEL, CA 94901-2850
(415) 454-5565
(415) 454-2957
Mailing address
901 E ST, STE 285, SAN RAFAEL, CA 94901-2850
(415) 454-5565
(415) 454-2957
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
11780
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
GR0015750
—
CA
Enumeration date
05/31/2005
Last updated
01/03/2022
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