Keith Yun Kong Wong, O.D.

Primary specialty

OptometristTaxonomy code 152W00000X

License

8152T Issued in CA

Practice address

3401 Dale Rd
Suite 300
Modesto, CA 95356-0505

Phone

(209) 574-0710

Fax

(209) 529-9030

NPI assigned

Dec 14, 2006

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 4

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

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.

• Fred WM Stellhorn Optometric Corporation

  • Optometrist
  • Manteca, CA
  • NPI 1124290721
  Medicare reassignment NPD
• Tedder Optometric Corporation, PC

  • Optometrist
  • Lake Forest, CA
  • NPI 1679262158
  Medicare reassignment

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

{
    "created_epoch": "1166054400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1678147200000",
    "number": "1336201615",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1608 LAVENDER LN",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953553771",
            "telephone_number": "209-521-5709"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3401 DALE RD",
            "address_2": "SUITE 300",
            "city": "MODESTO",
            "state": "CA",
            "postal_code": "953560505",
            "telephone_number": "209-574-0710",
            "fax_number": "209-529-9030"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WONG",
        "first_name": "KEITH",
        "middle_name": "YUN KONG",
        "name_prefix": "Dr.",
        "credential": "O.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-12-14",
        "last_updated": "2023-03-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "",
            "desc": "Optometrist",
            "state": "CA",
            "license": "8152T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "SD0081520",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "EYEMED",
            "identifier": "CA8152",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MES",
            "identifier": "14062",
            "state": "CA"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "STATE LICENSE",
            "identifier": "8152T",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Cheng Yi Wong, RD
• Elaine H Wong, MD
• Elizabeth Wong
• Jacquelyn Wong
• Karen Wong, OT
• Kent Hon-Wah Wong, MD
• Melinda F Wong
• Patrick Wong Jr., D.O
• Stephanie Shu Fen Wong
• Taylor Wong

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

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 7, 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.