Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 152WC0802X | Optomitrist - Corneal and Contact Lenses | OPT12376T | CA |
NPI | 1043210578 |
---|---|
Provider Name | Dr. Matthew Wang |
First Address | Irvine, CA 92618 |
Second Address | Irvine, CA 92618 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2005 |
Last Update Date | 17/09/2010 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
SD012376 | (05) | CA |
U96417 | (02) | CA |