Individual
DR. RANDALL VERNON WONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
3025 HAMAKER CT, SUITE 101, FAIRFAX, VA 22031-2237
(703) 876-9630
(703) 876-0163
Mailing address
3400 BEE RIDGE RD, STE 200, SARASOTA, FL 34239-7243
(703) 876-9630
(703) 876-0163
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
D0041207
MD
207W00000X
Ophthalmology Physician
Primary
D0041207
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
497691600
—
MD
Enumeration date
06/23/2005
Last updated
06/13/2016
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