Provider Demographics
NPI:1881831055
Name:XU, WENRONG (OD)
Entity Type:Individual
Prefix:
First Name:WENRONG
Middle Name:
Last Name:XU
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 1:8112 CLAYTON DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75025-4382
Mailing Address - Country:US
Mailing Address - Phone:214-529-6386
Mailing Address - Fax:
Practice Address - Street 1:3245 W MAIN ST STE 249
Practice Address - Street 2:
Practice Address - City:FRISCO
Practice Address - State:TX
Practice Address - Zip Code:75034-4412
Practice Address - Country:US
Practice Address - Phone:214-529-6386
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-09
Last Update Date:2009-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX7325TG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist