Provider Demographics
NPI:1265783047
Name:FANG, XIAOMIN (OD)
Entity type:Individual
Prefix:DR
First Name:XIAOMIN
Middle Name:
Last Name:FANG
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 1:200 REGAN RD
Mailing Address - Street 2:APT. 26C
Mailing Address - City:VERNON
Mailing Address - State:CT
Mailing Address - Zip Code:06066-2850
Mailing Address - Country:US
Mailing Address - Phone:781-330-2605
Mailing Address - Fax:
Practice Address - Street 1:180 RIVER RD
Practice Address - Street 2:WAL-MART VISION CENTER
Practice Address - City:LISBON
Practice Address - State:CT
Practice Address - Zip Code:06351-3249
Practice Address - Country:US
Practice Address - Phone:781-330-2605
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-20
Last Update Date:2012-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2864152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist