Provider Demographics
NPI:1891136941
Name:WAN, STEVEN SHING YAN (OD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:SHING YAN
Last Name:WAN
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 1:4515 E THOMAS RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85018-7614
Mailing Address - Country:US
Mailing Address - Phone:602-282-3285
Mailing Address - Fax:602-224-5380
Practice Address - Street 1:4515 E THOMAS RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85018-7614
Practice Address - Country:US
Practice Address - Phone:602-282-3285
Practice Address - Fax:602-224-5380
Is Sole Proprietor?:No
Enumeration Date:2013-07-17
Last Update Date:2021-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14674152W00000X
AZ1969152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist