Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152W00000X | Optometrist | 5265T | CA |
NPI | 1003959693 |
---|---|
Provider Name | Dr. Shirley Ann Fong |
First Address | Burlingame, CA 94010-3103 |
Second Address | Burlingame, CA 94010-3103 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 14/02/2007 |
Last Update Date | 08/07/2007 |