Provider Demographics
NPI:1477924173
Name:KONG, MARIANNA (OD)
Entity type:Individual
Prefix:DR
First Name:MARIANNA
Middle Name:
Last Name:KONG
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 1:6180 STATE FARM DR
Mailing Address - Street 2:
Mailing Address - City:ROHNERT PARK
Mailing Address - State:CA
Mailing Address - Zip Code:94928-2135
Mailing Address - Country:US
Mailing Address - Phone:707-584-7294
Mailing Address - Fax:707-584-4728
Practice Address - Street 1:6180 STATE FARM DR
Practice Address - Street 2:
Practice Address - City:ROHNERT PARK
Practice Address - State:CA
Practice Address - Zip Code:94928-2135
Practice Address - Country:US
Practice Address - Phone:707-584-7294
Practice Address - Fax:707-584-4728
Is Sole Proprietor?:No
Enumeration Date:2015-10-08
Last Update Date:2025-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15400152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist