MEDICARE: DOROTHY ZHIJUAN 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	4573	MA
2	152W00000X	Optometrist	13420	CA

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	WOP13420A	OTHER	CA	MEDICARE PROVIDER NUMBER

General Provider Information

NPI Number	:	1881743193
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DOROTHY ZHIJUAN WANG O.D.

Provider Business Mailing Address
First Line	:	13350 CAMINO DEL SUR
Second Line	:	SUITE 8
City	:	SAN DIEGO
State	:	CA
Zip	:	92129-4473
Country	:	US
Telephone Number	:	858-324-0089
Fax Number	:	858-324-0090

Provider Business Practice Location Address
First Line	:	13350 CAMINO DEL SUR
Second Line	:	SUITE 8
City	:	SAN DIEGO
State	:	CA
Zip	:	92129-4473
Country	:	US
Telephone Number	:	858-324-0089
Fax Number	:	858-324-0090

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

Provider Enumeration Date	:	01/09/2007
Last Update Date	:	09/08/2014

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