Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 156FX1100X | Ophthalmic | ||
Y | 156FX1800X | Optician | 009419 | NY |
NPI | 1841969995 |
---|---|
Provider Name | Ryan Wong |
First Address | Little Neck, NY 11362-1354 |
Second Address | Little Neck, NY 11362-1354 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/09/2021 |
Last Update Date | 12/09/2021 |