Provider Demographics
NPI:1356915979
Name:ASHLEY WONG, LLC
Entity type:Organization
Organization Name:ASHLEY WONG, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC OPTOMETRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:301-385-2840
Mailing Address - Street 1:9308 BISHOPGATE DR
Mailing Address - Street 2:
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21704-7356
Mailing Address - Country:US
Mailing Address - Phone:301-385-2840
Mailing Address - Fax:
Practice Address - Street 1:3272 BENNETT CREEK AVE
Practice Address - Street 2:UNIT B
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704
Practice Address - Country:US
Practice Address - Phone:301-732-7988
Practice Address - Fax:301-732-7881
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PEAS, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatricsGroup - Single Specialty