Lisa Amanda Wong, OD

Primary specialty

OptometristTaxonomy code 152W00000X

License

34769 Issued in CA

Practice address

417 Sycamore Valley Rd W
Danville, CA 94526-3951

Phone

(925) 838-3021

NPI assigned

Jul 16, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Specialty

Optometry

Education

Illinois College of Optometry at Chicago, 2019

Medicare assignment

May accept Medicare assignment

Group practices

Vision Dynamics Optometric CenterGroup PAC ID 9234388562, 2 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Vision Dynamics Optometric Center

  • Optometrist
  • Danville, CA
  • NPI 1023378635
  Medicare reassignment Care Compare group NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1563235200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1693612800000",
    "number": "1053963363",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "417 SYCAMORE VALLEY RD W",
            "city": "DANVILLE",
            "state": "CA",
            "postal_code": "945263951"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "417 SYCAMORE VALLEY RD W",
            "city": "DANVILLE",
            "state": "CA",
            "postal_code": "945263951",
            "telephone_number": "925-838-3021"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WONG",
        "first_name": "LISA",
        "middle_name": "AMANDA",
        "credential": "OD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-16",
        "last_updated": "2023-09-02",
        "certification_date": "2023-09-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "34769",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "NY",
            "license": "009018-01",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Anna Nicole Wolfson
• Annie Louie Wong, D.D.S.
• Bradford Wong, PT, MPA
• Joshua Wong, D.D.S
• Juliana C Wong, M.D.
• Stacie Anne Wong, PT, DPT
• Juliet L Wouden, D.D.S.
• Grant Wyborny, PH.D.
• Lacey Xepoleas, PSY.D.
• Pei Xiao

• Optometrist in Danville, CA
• Providers in Danville, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 2, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.