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General NPI Number Information
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NPI Number | 1487084034
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Entity Type | Organization
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Legal Business Name | DOROTHY Z WANG OPTOMETRY INC
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Dates
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Enumeration Date | 11/19/2013
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Last Update Date | 09/08/2014
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Provider Practice Location Address
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Address Line | 13350 CAMINO DEL SUR SUITE 8
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City | SAN DIEGO
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State | CA
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Zip | 92129-4473
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Country | US
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Telephone | 858-324-0089
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Fax | 858-324-0090
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Provider Business Mailing Address
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Address Line | 13350 CAMINO DEL SUR SUITE 8
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City | SAN DIEGO
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State | CA
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Zip | 92129-4473
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Country | US
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Telephone | 858-324-0089
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Fax | 858-324-0090
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | DR. DOROTHY ZHIJUAN WANG
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Credential | O.D.
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Telephone | 858-324-0089
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 13420
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License Number State | CA
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