Provider Demographics
NPI:1265920920
Name:WANG, WEIXUN (OD)
Entity type:Individual
Prefix:
First Name:WEIXUN
Middle Name:
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 1:969 MAIN ST STE H
Mailing Address - Street 2:
Mailing Address - City:FISHKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12524-1791
Mailing Address - Country:US
Mailing Address - Phone:845-896-6700
Mailing Address - Fax:845-896-6882
Practice Address - Street 1:969 MAIN ST STE H
Practice Address - Street 2:
Practice Address - City:FISHKILL
Practice Address - State:NY
Practice Address - Zip Code:12524-1791
Practice Address - Country:US
Practice Address - Phone:845-896-6700
Practice Address - Fax:845-896-6882
Is Sole Proprietor?:No
Enumeration Date:2018-04-27
Last Update Date:2019-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYTUV008764152W00000X, 152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist