Provider Demographics
NPI:1639434442
Name:WANG, BETTY (OD)
Entity Type:Individual
Prefix:
First Name:BETTY
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:OD
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:32701-4798
Mailing Address - Country:US
Mailing Address - Phone:407-834-7776
Mailing Address - Fax:407-834-0973
Practice Address - Street 1:787 HEALTH CARE DR
Practice Address - Street 2:
Practice Address - City:ORANGE CITY
Practice Address - State:FL
Practice Address - Zip Code:32763-8325
Practice Address - Country:US
Practice Address - Phone:386-668-4332
Practice Address - Fax:386-668-4115
Is Sole Proprietor?:No
Enumeration Date:2012-07-08
Last Update Date:2013-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002631152W00000X
FLOPC 4779152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHJ270YMedicare PIN
FLHJ270ZMedicare PIN