1417347014 NPI number — HOWARD C. WANG, O.D., A PROFESSIONAL CORPORATION

Table of content: (NPI 1417347014)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1417347014 NPI number — HOWARD C. WANG, O.D., A PROFESSIONAL CORPORATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HOWARD C. WANG, O.D., A PROFESSIONAL CORPORATION
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
MODERN EYES OPTOMETRY
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1417347014
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/03/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7630 VIA CAMPANILE
Provider Second Line Business Mailing Address:
SUITE 134
Provider Business Mailing Address City Name:
CARLSBAD
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92009-8486
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
760-613-9526
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7630 VIA CAMPANILE
Provider Second Line Business Practice Location Address:
SUITE 134
Provider Business Practice Location Address City Name:
CARLSBAD
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92009-8486
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
760-613-9526
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/03/2015

Additional Information

Authorized Official

Authorized Official Last Name:
WANG
Authorized Official First Name:
HOWARD
Authorized Official Middle Name:
CHIA-HAO
Authorized Official Title or Position:
PRESIDENT/CEO
Authorized Official Telephone Number:
760-613-9526

Provider Taxonomy Codes

  • Taxonomy code: 152W00000X , with the licence number:  12673T , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2024 www.npivalidator.com