Provider Demographics
NPI:1255469433
Name:WANG, HOWARD C (OD)
Entity Type:Individual
Prefix:
First Name:HOWARD
Middle Name:C
Last Name:WANG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:648 WEATHERSTONE WAY
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:CA
Mailing Address - Zip Code:92078-1095
Mailing Address - Country:US
Mailing Address - Phone:760-613-9526
Mailing Address - Fax:951-296-0342
Practice Address - Street 1:7630 VIA CAMPANILE
Practice Address - Street 2:SUITE 134
Practice Address - City:CARLSBAD
Practice Address - State:CA
Practice Address - Zip Code:92009-8486
Practice Address - Country:US
Practice Address - Phone:760-613-9526
Practice Address - Fax:760-539-7202
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12673152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAV01478Medicare UPIN