Provider Demographics
NPI:1780661298
Name:WANG, ABHNER ROYCEE (OD)
Entity Type:Individual
Prefix:DR
First Name:ABHNER
Middle Name:ROYCEE
Last Name:WANG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2077 LYNNHAVEN PKWY STE 101
Mailing Address - Street 2:
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23456-4884
Mailing Address - Country:US
Mailing Address - Phone:757-426-2020
Mailing Address - Fax:757-390-2948
Practice Address - Street 1:2033 FISCHER ARCH
Practice Address - Street 2:SUITE 150
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23456
Practice Address - Country:US
Practice Address - Phone:757-426-2020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-12-27
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0618001356152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1780661298Medicaid
VAVV7396C765OtherMEDICARE PTAN