Healthcare Provider Details

I. General information

NPI: 1972910578
Provider Name (Legal Business Name): WENJUN HUANG O.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/15/2014
Last Update Date: 07/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7605 MORRO RD
ATASCADERO CA
93422
US

IV. Provider business mailing address

7605 MORRO RD
ATASCADERO CA
93422-4433
US

V. Phone/Fax

Practice location:
  • Phone: 805-466-3777
  • Fax: 805-466-3700
Mailing address:
  • Phone: 54-663-3777
  • Fax: 805-466-3700

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number15056
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: