Provider Demographics
NPI:1043426711
Name:WANG, WILLIAM WHA (OD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:WHA
Last Name:WANG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
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Mailing Address - Street 1:2439 BREWER WAY NE
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-2216
Mailing Address - Country:US
Mailing Address - Phone:770-974-8646
Mailing Address - Fax:770-974-5188
Practice Address - Street 1:3105 COBB PKWY NW
Practice Address - Street 2:
Practice Address - City:KENNESAW
Practice Address - State:GA
Practice Address - Zip Code:30152-1013
Practice Address - Country:US
Practice Address - Phone:770-974-8646
Practice Address - Fax:770-974-5188
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-16
Last Update Date:2015-05-21
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
GA1901152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA202G419552Medicare Oscar/Certification
GA202I419552Medicare PIN