Provider Demographics
NPI:1700944154
Name:WAND, OSCAR (MD)
Entity Type:Individual
Prefix:DR
First Name:OSCAR
Middle Name:
Last Name:WAND
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:65 VALENCIA CT
Mailing Address - Street 2:
Mailing Address - City:PORTOLA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:94028-7923
Mailing Address - Country:US
Mailing Address - Phone:650-851-1858
Mailing Address - Fax:
Practice Address - Street 1:65 VALENCIA CT
Practice Address - Street 2:
Practice Address - City:PORTOLA VALLEY
Practice Address - State:CA
Practice Address - Zip Code:94028-7923
Practice Address - Country:US
Practice Address - Phone:650-851-1858
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG12319207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG12919OtherMEDICAL LICENSE