Provider Demographics
NPI:1548984636
Name:WONG, JOYCELYN (OD)
Entity type:Individual
Prefix:DR
First Name:JOYCELYN
Middle Name:
Last Name:WONG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:6600 TOPANGA CANYON BLVD UNIT 1034
Mailing Address - Street 2:
Mailing Address - City:CANOGA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91303-2654
Mailing Address - Country:US
Mailing Address - Phone:213-212-7787
Mailing Address - Fax:
Practice Address - Street 1:6600 TOPANGA CANYON BLVD UNIT 1034
Practice Address - Street 2:
Practice Address - City:CANOGA PARK
Practice Address - State:CA
Practice Address - Zip Code:91303-2654
Practice Address - Country:US
Practice Address - Phone:213-212-7787
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-03
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35197152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist