Provider Demographics
NPI:1396993325
Name:WONG, ANNELIESE LIRR CHEIN (OD)
Entity type:Individual
Prefix:DR
First Name:ANNELIESE
Middle Name:LIRR CHEIN
Last Name:WONG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3655 DORENA PL
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-6238
Mailing Address - Country:US
Mailing Address - Phone:510-375-4690
Mailing Address - Fax:
Practice Address - Street 1:950 THARP RD
Practice Address - Street 2:SUITE 1500
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95993-8344
Practice Address - Country:US
Practice Address - Phone:530-671-7100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-09-03
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR3285AT152W00000X
CA13701 TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist