Carolyn Marie Wong, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

OP7450 Issued in CA

Practice address

11540 Santa Monica Blvd
Suite 202
Los Angeles, CA 90025-7905

Phone

(310) 473-5464

Fax

(310) 473-2536

NPI assigned

Feb 22, 2007

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other identifiers 1

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

Southern California College of Optometry, 1982

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Chan Nhu Diep, O.D.

  • Optometrist
  • Los Angeles, CA
  • NPI 1073814174
  Medicare reassignment
• Grace Kim

  • Optometrist
  • Los Angeles, CA
  • NPI 1770161465
  Medicare reassignment
• Denise Lynn Lemke, OD

  • Optometrist
  • Redondo Beach, CA
  • NPI 1215810528
  Medicare reassignment
• Jenilee Liang

  • Optometrist
  • Los Angeles, CA
  • NPI 1346079472
  Medicare reassignment
• Madeleine Rae Low, OD

  • Optometrist
  • Los Angeles, CA
  • NPI 1588046734
  Medicare reassignment
• Austin Ofreneo, OD

  • Optometrist
  • Stevenson Ranch, CA
  • NPI 1568742591
  Medicare reassignment

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.

• Dr. Carolyn Wong

  • Optometrist
  • Los Angeles, CA
  • NPI 1710137708
  NPD Authorized official

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

{
    "created_epoch": "1172102400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1580860800000",
    "number": "1306971429",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11540 SANTA MONICA BLVD",
            "address_2": "SUITE 202",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900257905",
            "telephone_number": "310-473-5464",
            "fax_number": "310-473-2536"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11540 SANTA MONICA BLVD",
            "address_2": "SUITE 202",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900257905",
            "telephone_number": "310-473-5464",
            "fax_number": "310-473-2536"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WONG",
        "first_name": "CAROLYN",
        "middle_name": "MARIE",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-02-22",
        "last_updated": "2020-02-05",
        "certification_date": "2020-02-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "OP7450",
            "primary": true
        },
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "7450T",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0074500",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Brian Gordon Wong
• Brian Matthew Wong, PHARMD
• Cadence Wong
• Carl Lew Wong, LCSW
• Carolyn Wong, DPM
• Carrie Ruby Wong, M.D.
• Catherine Wong
• Charisse Wong, PHARMD
• Chihan Wong, M.D.
• Ching (Phoebe) Wong

• Optometrist in Los Angeles, CA
• Providers in Los Angeles, CA by specialty
• Optometrist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 5, 2020; 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.