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General NPI Number Information
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NPI Number | 1871559872
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Entity Type | Individual
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Provider Name | KATHERINE L WANG OD
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Gender | Female
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Dates
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Enumeration Date | 04/26/2006
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Last Update Date | 05/08/2014
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Provider Practice Location Address
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Address Line | 1830 WEST DR SUITE 107 NORTH COUNTY VA OUTPATIENT CLINIC
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City | VISTA
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State | CA
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Zip | 92083-6125
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Country | US
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Telephone | 760-643-2089
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Fax | 760-643-2099
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Provider Business Mailing Address
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Address Line | 535 DEW POINT AVE
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City | CARLSBAD
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State | CA
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Zip | 92011-4669
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Country | US
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Telephone | 760-918-0949
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Fax | 760-918-0626
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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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 | 12063T
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License Number State | CA
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