Provider Demographics
NPI:1487084034
Name:DOROTHY Z WANG OPTOMETRY INC
Entity type:Organization
Organization Name:DOROTHY Z WANG OPTOMETRY INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:DOROTHY
Authorized Official - Middle Name:ZHIJUAN
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:858-324-0089
Mailing Address - Street 1:13350 CAMINO DEL SUR
Mailing Address - Street 2:SUITE 8
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-4473
Mailing Address - Country:US
Mailing Address - Phone:858-324-0089
Mailing Address - Fax:858-324-0090
Practice Address - Street 1:13350 CAMINO DEL SUR
Practice Address - Street 2:SUITE 8
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-4473
Practice Address - Country:US
Practice Address - Phone:858-324-0089
Practice Address - Fax:858-324-0090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-19
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA13420152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB207296Medicare PIN