MEDICARE: MICHAEL WANG OD.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	152W00000X	Optometrist	OPT10004TPA	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104820950
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MICHAEL WANG OD.

Provider Business Mailing Address
First Line	:	9727 ELK GROVE FLORIN RD
Second Line	:	#190
City	:	ELK GROVE
State	:	CA
Zip	:	95624-2264
Country	:	US
Telephone Number	:	916-686-5165
Fax Number	:	916-686-5865

Provider Business Practice Location Address
First Line	:	9727 ELK GROVE FLORIN RD
Second Line	:	#190
City	:	ELK GROVE
State	:	CA
Zip	:	95624-2264
Country	:	US
Telephone Number	:	916-686-5165
Fax Number	:	916-686-5865

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/09/2005
Last Update Date	:	06/17/2013

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Directions to “ MICHAEL WANG OD.” Practice Location

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