MEDICARE: LAWRENCE WANG OD INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	NV0392	NV

General Provider Information

NPI Number	:	1033308440
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LAWRENCE WANG OD INC

Provider Business Mailing Address
First Line	:	PO BOX 33849
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89133-3849
Country	:	US
Telephone Number	:	702-515-7240
Fax Number	:	702-222-4308

Provider Business Practice Location Address
First Line	:	3615 S RAINBOW BLVD
Second Line	:	STE 110
City	:	LAS VEGAS
State	:	NV
Zip	:	89103-1057
Country	:	US
Telephone Number	:	702-515-7240
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. LAWRENCE WANG
Credential	:	OD
Telephone Number	:	702-515-7240

Provider Enumeration Date	:	10/22/2007
Last Update Date	:	10/22/2007

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