NPIMap

Organization Active NPI

Dr. Carolyn Wong

  • Optometrist
  • Los Angeles, CA
National Provider Identifier
1710137708
Registry record updated Jul 31, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
OptometristTaxonomy code 152W00000X
License
7450T Issued in CA
Legal business name
DR. CAROLYN WONG
Practice address
11540 Santa Monica Blvd
Suite 202
Los Angeles, CA 90025-7905
Phone
(310) 473-5464
NPI assigned
Sep 25, 2008
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 31, 2025

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

Authorized official

Name
Carolyn M Wong, O.D.NPI 1306971429
Title
Owner/Optometrist
Phone
(310) 473-5464

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
OptometristGroup: 193400000X SINGLE SPECIALTY GROUP 152W00000X 7450T CA Primary

Addresses

Primary practice location

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

Mailing address

11540 Santa Monica Blvd
Suite 202
Los Angeles, CA 90025-7905
Phone (310) 473-5464

Other identifiers 1

IdentifierTypeStateIssuer
GSD001670MedicaidCA

National Provider Directory

National Provider Directory

Locations

11540 Santa Monica Blvd
Ste 202
Los Angeles, CA 90025
Phone (310) 473-5464

Practitioners & affiliated clinicians

Practitioners 10

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

NPI Registry JSON

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

{
    "created_epoch": "1222300800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1753920000000",
    "number": "1710137708",
    "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"
        },
        {
            "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"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DR. CAROLYN WONG",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-09-25",
        "last_updated": "2025-07-31",
        "certification_date": "2025-07-31",
        "status": "A",
        "authorized_official_last_name": "WONG",
        "authorized_official_first_name": "CAROLYN",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER/OPTOMETRIST",
        "authorized_official_telephone_number": "310-473-5464",
        "authorized_official_credential": "O.D."
    },
    "taxonomies": [
        {
            "code": "152W00000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Optometrist",
            "state": "CA",
            "license": "7450T",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "GSD001670",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 31, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.