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General NPI Number Information
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NPI Number | 1568876852
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Entity Type | Organization
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Legal Business Name | CYA OPTOMETRY CORPORATION
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Dates
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Enumeration Date | 06/16/2014
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Last Update Date | 08/08/2018
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Provider Practice Location Address
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Address Line | 945 ARMORY RD STE C
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City | BARSTOW
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State | CA
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Zip | 92311
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Country | US
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Telephone | 760-252-7518
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Fax | 760-252-7510
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Provider Business Mailing Address
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Address Line | 945 ARMORY RD SUITE C
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City | BARSTOW
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State | CA
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Zip | 92311-5401
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Country | US
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Telephone | 760-252-7518
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Fax | 760-252-7510
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. CHENG YU A WANG
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Credential | OD
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Telephone | 760-252-7518
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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 | 14004
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License Number State | CA
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