Provider Demographics
NPI:1518955905
Name:WANG, JANE (MD)
Entity Type:Individual
Prefix:DR
First Name:JANE
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 1:7025 HICKMAN RD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50322-4843
Mailing Address - Country:US
Mailing Address - Phone:515-270-2486
Mailing Address - Fax:515-270-8512
Practice Address - Street 1:7025 HICKMAN RD
Practice Address - Street 2:SUITE 1
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50322-4843
Practice Address - Country:US
Practice Address - Phone:515-270-2486
Practice Address - Fax:515-270-8512
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA22284152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0175653Medicaid
IA0175653Medicaid
IAA01925Medicare UPIN