Provider Demographics
NPI:1609179803
Name:WANG OPTOMETRIC ASSOCIATES INC.
Entity Type:Organization
Organization Name:WANG OPTOMETRIC ASSOCIATES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHENG YU
Authorized Official - Middle Name:
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:951-422-2381
Mailing Address - Street 1:15908 BEAR VALLEY RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-9547
Mailing Address - Country:US
Mailing Address - Phone:760-243-4559
Mailing Address - Fax:760-243-2052
Practice Address - Street 1:15908 BEAR VALLEY RD
Practice Address - Street 2:SUITE A
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-9547
Practice Address - Country:US
Practice Address - Phone:760-243-4559
Practice Address - Fax:760-243-2052
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-09
Last Update Date:2018-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAOPT8032TPA152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CASD0080320Medicaid
CAEV797AOtherMEDICARE PTAN
CAT70248Medicare UPIN