=====================================================
General NPI Number Information
=====================================================
NPI Number | 1417347014
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HOWARD C. WANG, O.D., A PROFESSIONAL CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/03/2015
-----------------------------------------------------
Last Update Date | 02/03/2015
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7630 VIA CAMPANILE SUITE 134
-----------------------------------------------------
City | CARLSBAD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92009-8486
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-613-9526
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7630 VIA CAMPANILE SUITE 134
-----------------------------------------------------
City | CARLSBAD
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92009-8486
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-613-9526
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | HOWARD CHIA-HAO WANG
-----------------------------------------------------
Credential | O.D.
-----------------------------------------------------
Telephone | 760-613-9526
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 152W00000X
-----------------------------------------------------
Taxonomy Name | Optometrist
-----------------------------------------------------
License Number | 12673T
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------