Provider Demographics
NPI:1639549702
Name:WANG, EVA MAYE
Entity Type:Individual
Prefix:DR
First Name:EVA
Middle Name:MAYE
Last Name:WANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 S END AVE
Mailing Address - Street 2:35U
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10280-1014
Mailing Address - Country:US
Mailing Address - Phone:917-670-5220
Mailing Address - Fax:
Practice Address - Street 1:375 S END AVE
Practice Address - Street 2:35U
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10280-1014
Practice Address - Country:US
Practice Address - Phone:917-670-5220
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-10-01
Last Update Date:2015-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT005191152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist