Provider Demographics
NPI:1235799289
Name:WANG, ERIC DAVID (OD)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:DAVID
Last Name:WANG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3100 OHIO DR APT 120
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-6584
Mailing Address - Country:US
Mailing Address - Phone:713-820-2255
Mailing Address - Fax:
Practice Address - Street 1:221 N PRESTON RD STE B
Practice Address - Street 2:
Practice Address - City:PROSPER
Practice Address - State:TX
Practice Address - Zip Code:75078-8607
Practice Address - Country:US
Practice Address - Phone:972-347-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9675152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist