Provider Demographics
NPI:1750331658
Name:WANG, IPU EMILY (OD)
Entity Type:Individual
Prefix:MRS
First Name:IPU
Middle Name:EMILY
Last Name:WANG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MRS
Other - First Name:EMILY
Other - Middle Name:
Other - Last Name:WANG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:OD
Mailing Address - Street 1:2730 SMITH RANCH RD.
Mailing Address - Street 2:STE 114
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77584
Mailing Address - Country:US
Mailing Address - Phone:713-436-4816
Mailing Address - Fax:713-436-3546
Practice Address - Street 1:2730 SMITH RANCH RD.
Practice Address - Street 2:STE 114
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77584
Practice Address - Country:US
Practice Address - Phone:713-436-4816
Practice Address - Fax:713-436-3546
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-11
Last Update Date:2007-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX6529TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX611805Medicare ID - Type Unspecified
TXV05382Medicare UPIN