MEDICARE: DR. MINGJUN MICHAEL WANG O. D.

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	OEG000005	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PA09830	OTHER	PA	VBA
2	2159259830	OTHER	PA	VSP
3	2179183000	OTHER	PA	KEYSTONE HEALTH PLAN EAST
4	42203	OTHER	PA	DAVIS VISION
5	20031	OTHER	PR	SPECTERA
6	397523	OTHER	PA	NVA
7	WA1489384	OTHER	PA	HIGH MARK BLUE SHIELD
8	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
9	348399	OTHER	PA	AETNA
10	1489384	OTHER	PA	PERSONAL CHOICE

General Provider Information

NPI Number	:	1770569386
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MINGJUN MICHAEL WANG O. D.

Provider Business Mailing Address
First Line	:	10066 PACIFIC HEIGHTS BLVD
Second Line	:	SUITE 112
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-4211
Country	:	US
Telephone Number	:	858-526-0890
Fax Number	:	858-526-0899

Provider Business Practice Location Address
First Line	:	10066 PACIFIC HEIGHTS BLVD
Second Line	:	SUITE 112
City	:	SAN DIEGO
State	:	CA
Zip	:	92121-4211
Country	:	US
Telephone Number	:	858-526-0890
Fax Number	:	858-526-0899

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

Provider Enumeration Date	:	12/16/2005
Last Update Date	:	05/20/2015

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Directions to “ DR. MINGJUN MICHAEL WANG O. D.” Practice Location

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