Provider Demographics
NPI:1649294174
Name:WANG, CINDY PUNG (OD)
Entity type:Individual
Prefix:DR
First Name:CINDY
Middle Name:PUNG
Last Name:WANG
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 1:729 MISSION ST STE 200
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-3072
Mailing Address - Country:US
Mailing Address - Phone:626-441-5300
Mailing Address - Fax:626-441-2880
Practice Address - Street 1:729 MISSION ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SOUTH PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91030-3069
Practice Address - Country:US
Practice Address - Phone:626-441-5300
Practice Address - Fax:626-441-2880
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2022-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11206T152WL0500X, 152WP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WP0200XEye and Vision Services ProvidersOptometristPediatrics
No152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA2535OtherDAVIS VISION
CA13818OtherMEDICAL EYE SERVICES
CAWOP11206AMedicare ID - Type UnspecifiedPPIN NUMBER
CA13818OtherMEDICAL EYE SERVICES