Healthcare Provider Details

I. General information

NPI: 1154213916
Provider Name (Legal Business Name): SERENA YEE-TING WANG OD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/16/2025
Last Update Date: 05/12/2026
Certification Date: 05/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

940 BELMONT ST
BROCKTON MA
02301-5568
US

IV. Provider business mailing address

33 POND AVE APT 1024
BROOKLINE MA
02445-7158
US

V. Phone/Fax

Practice location:
  • Phone: 774-826-1106
  • Fax:
Mailing address:
  • Phone: 626-818-3028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number8328
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: