Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 14221 | CA |
NPI | 1003196049 |
---|---|
Provider Name | Christopher Jeffrey Fong |
First Address | Oakland, CA 94602-3017 |
Second Address | Pleasanton, CA 94588-3219 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2011 |
Last Update Date | 22/08/2011 |