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General NPI Number Information
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NPI Number | 1952877102
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Entity Type | Organization
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Legal Business Name | MICHAEL WANG
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Dates
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Enumeration Date | 10/15/2018
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Last Update Date | 03/16/2022
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Provider Practice Location Address
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Address Line | 9727 ELK GROVE FLORIN RD STE 190
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City | ELK GROVE
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State | CA
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Zip | 95624-2267
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Country | US
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Telephone | 916-686-5165
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Fax | 916-686-5865
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Provider Business Mailing Address
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Address Line | 9727 ELK GROVE FLORIN RD STE 190
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City | ELK GROVE
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State | CA
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Zip | 95624-2267
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Country | US
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Telephone | 916-686-5165
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Fax | 916-686-5865
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Authorized Official
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Title or Position | PARTNER
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Name | LYNN BUTTINO
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Credential | OD
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Telephone | 916-686-5165
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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 |
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License Number State |
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