Provider Demographics
NPI:1093453128
Name:WANG, EMILY JOANNA (OD)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:JOANNA
Last Name:WANG
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 1:5951 SOUTH LOOP E UNIT 52
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77033-1055
Mailing Address - Country:US
Mailing Address - Phone:713-992-2911
Mailing Address - Fax:
Practice Address - Street 1:5330 E MOCKINGBIRD LN STE 130
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75206-0961
Practice Address - Country:US
Practice Address - Phone:214-341-9955
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-05-27
Last Update Date:2022-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
TX10637152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program