Provider Demographics
NPI:1902889009
Name:ONG, TIFFANY M (OD)
Entity Type:Individual
Prefix:DR
First Name:TIFFANY
Middle Name:M
Last Name:ONG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MRS
Other - First Name:TIFFANY
Other - Middle Name:M
Other - Last Name:LEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:22732 CYPRESS ST
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90501-5338
Mailing Address - Country:US
Mailing Address - Phone:310-530-0899
Mailing Address - Fax:
Practice Address - Street 1:3200 N SEPULVEDA BLVD
Practice Address - Street 2:SUITE E4
Practice Address - City:MANHATTAN BEACH
Practice Address - State:CA
Practice Address - Zip Code:90266-2458
Practice Address - Country:US
Practice Address - Phone:310-546-5568
Practice Address - Fax:310-546-5421
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11722T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASO0011722Medicaid
CASO0011722Medicaid