Provider Demographics
NPI:1306837562
Name:WANG, CATHERINE (MD)
Entity Type:Individual
Prefix:
First Name:CATHERINE
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:160 BOSTON AVE
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32701-4706
Mailing Address - Country:US
Mailing Address - Phone:407-775-7654
Mailing Address - Fax:407-834-6082
Practice Address - Street 1:10131 W COLONIAL DR
Practice Address - Street 2:SUITE 201
Practice Address - City:OCOEE
Practice Address - State:FL
Practice Address - Zip Code:34761-4221
Practice Address - Country:US
Practice Address - Phone:407-834-7776
Practice Address - Fax:407-834-0973
Is Sole Proprietor?:No
Enumeration Date:2005-11-04
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME88090207W00000X, 207WX0009X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0009XAllopathic & Osteopathic PhysiciansOphthalmologyGlaucoma Specialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL268390300Medicaid
FLBW8414079OtherDEA#
FLU1341VMedicare PIN
FLU1341YMedicare PIN
FLU1341ZMedicare PIN
FLBW8414079OtherDEA#
FLU1341WMedicare PIN