Provider Demographics
NPI:1699768895
Name:WONG, SHU TZU (PHD)
Entity type:Individual
Prefix:
First Name:SHU
Middle Name:TZU
Last Name:WONG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:JUDY
Other - Middle Name:SHUTZU
Other - Last Name:WONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:2301 S WATER ST
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67213-4819
Mailing Address - Country:US
Mailing Address - Phone:316-682-4646
Mailing Address - Fax:316-263-4116
Practice Address - Street 1:2301 S WATER ST
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67213-4819
Practice Address - Country:US
Practice Address - Phone:316-682-4646
Practice Address - Fax:316-263-4116
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS4410152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation