Provider Demographics
NPI:1598817926
Name:WANG, CHRISTINA (OD)
Entity Type:Individual
Prefix:DR
First Name:CHRISTINA
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MRS
Other - First Name:CHRISTINA
Other - Middle Name:
Other - Last Name:TAGUCHI
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:3217 153RD PL SE
Mailing Address - Street 2:
Mailing Address - City:MILL CREEK
Mailing Address - State:WA
Mailing Address - Zip Code:98012-7834
Mailing Address - Country:US
Mailing Address - Phone:425-870-5510
Mailing Address - Fax:
Practice Address - Street 1:15407 MAIN ST
Practice Address - Street 2:E103
Practice Address - City:MILL CREEK
Practice Address - State:WA
Practice Address - Zip Code:98012-7375
Practice Address - Country:US
Practice Address - Phone:425-357-8234
Practice Address - Fax:425-357-1333
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2013-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA3707152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist