Provider Demographics
NPI:1073785440
Name:WANG EYE CLINIC
Entity Type:Organization
Organization Name:WANG EYE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ZHENGXIANG
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:770-457-0012
Mailing Address - Street 1:2505 CHAMBLEE TUCKER RD
Mailing Address - Street 2:SUITE 207
Mailing Address - City:CHAMBLEE
Mailing Address - State:GA
Mailing Address - Zip Code:30341-3526
Mailing Address - Country:US
Mailing Address - Phone:770-457-0012
Mailing Address - Fax:770-457-0014
Practice Address - Street 1:2505 CHAMBLEE TUCKER RD
Practice Address - Street 2:SUITE 207
Practice Address - City:CHAMBLEE
Practice Address - State:GA
Practice Address - Zip Code:30341-3526
Practice Address - Country:US
Practice Address - Phone:770-457-0012
Practice Address - Fax:770-457-0014
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-26
Last Update Date:2008-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA056379207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA18BDGMJMedicare PIN
GAI37872Medicare UPIN