Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207W00000X | Ophthalmologist | H3961 | TX |
N | 207WX0107X | Retina Specialist | H3961 | TX |
NPI | 1003914151 |
---|---|
Provider Name | Tien Wong |
First Address | Houston, TX 77030-2727 |
Second Address | Houston, TX 77030-2727 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 29/03/2017 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
10019568 | AMERIGROUP (01) | TX |
10019568 | AMERIVANTAGE (01) | TX |
101319501 | (05) | TX |
101319502 | (05) | TX |
1534421 | (05) | LA |
19422 | OPTICARE (01) | TX |
26010 | SELECTCARE OF TEXAS (01) | TX |
4310136 | AETNA (01) | TX |
80G068 | BLUE SHIELD (01) | TX |
E89756 | (02) | TX |
E89756 | STERLING OPTION ONE (01) | TX |
H3961 | UNICARE (01) | TX |