Provider Demographics
NPI:1316129927
Name:EDDIE C. WANG, O.D., PROFESSIONAL OPTOMETRIC CORPORATION
Entity type:Organization
Organization Name:EDDIE C. WANG, O.D., PROFESSIONAL OPTOMETRIC CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OPTOMETRIST OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:EDDIE
Authorized Official - Middle Name:C
Authorized Official - Last Name:WANG
Authorized Official - Suffix:
Authorized Official - Credentials:OD
Authorized Official - Phone:562-696-1883
Mailing Address - Street 1:8522 PAINTER AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:WHITTIER
Mailing Address - State:CA
Mailing Address - Zip Code:90602-3335
Mailing Address - Country:US
Mailing Address - Phone:562-696-1883
Mailing Address - Fax:562-696-8878
Practice Address - Street 1:8522 PAINTER AVE
Practice Address - Street 2:SUITE A
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90602-3335
Practice Address - Country:US
Practice Address - Phone:562-696-1883
Practice Address - Fax:562-696-8878
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-05
Last Update Date:2007-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11974TPL152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes152W00000XEye and Vision Services ProvidersOptometristGroup - Single Specialty