Healthcare Provider Details

I. General information

NPI: 1821135492
Provider Name (Legal Business Name): SHYH JYE WANG O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/31/2007
Last Update Date: 09/30/2024
Certification Date: 09/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9103 S 1300 W STE 102
WEST JORDAN UT
84088-6709
US

IV. Provider business mailing address

11676 S SILVER POND DR
SOUTH JORDAN UT
84009-1762
US

V. Phone/Fax

Practice location:
  • Phone: 801-417-0131
  • Fax:
Mailing address:
  • Phone: 469-835-5748
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number13134283-9934
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number6768
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: