Provider Demographics
NPI:1417347014
Name:HOWARD C. WANG, O.D., A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:HOWARD C. WANG, O.D., A PROFESSIONAL CORPORATION
Other - Org Name:MODERN EYES OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:HOWARD
Authorized Official - Middle Name:CHIA-HAO
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:760-613-9526
Mailing Address - Street 1:7630 VIA CAMPANILE
Mailing Address - Street 2:SUITE 134
Mailing Address - City:CARLSBAD
Mailing Address - State:CA
Mailing Address - Zip Code:92009-8486
Mailing Address - Country:US
Mailing Address - Phone:760-613-9526
Mailing Address - Fax:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-03
Last Update Date:2015-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12673T152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty