Provider Demographics
NPI:1952877102
Name:MICHAEL WANG
Entity Type:Organization
Organization Name:MICHAEL WANG
Other - Org Name:WANG OPTOMETRY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:LYNN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTTINO
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:916-686-5165
Mailing Address - Street 1:9727 ELK GROVE FLORIN RD STE 190
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-2267
Mailing Address - Country:US
Mailing Address - Phone:916-686-5165
Mailing Address - Fax:916-686-5865
Practice Address - Street 1:9727 ELK GROVE FLORIN RD STE 190
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-2267
Practice Address - Country:US
Practice Address - Phone:916-686-5165
Practice Address - Fax:916-686-5865
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-10-15
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty