Provider Demographics
NPI:1285061366
Name:WANG, QIAOQIAO (PHD, OD)
Entity type:Individual
Prefix:DR
First Name:QIAOQIAO
Middle Name:
Last Name:WANG
Suffix:
Gender:F
Credentials:PHD, OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2514 BOSTON POST RD STE 1C
Mailing Address - Street 2:
Mailing Address - City:GUILFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06437-1339
Mailing Address - Country:US
Mailing Address - Phone:203-453-4813
Mailing Address - Fax:203-738-0523
Practice Address - Street 1:2514 BOSTON POST RD STE 1C
Practice Address - Street 2:
Practice Address - City:GUILFORD
Practice Address - State:CT
Practice Address - Zip Code:06437-1339
Practice Address - Country:US
Practice Address - Phone:203-453-4813
Practice Address - Fax:203-738-0523
Is Sole Proprietor?:No
Enumeration Date:2013-10-03
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT2902152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist