Provider Demographics
NPI:1316910813
Name:WANG-HARRIS, SANDRA E (OD)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:E
Last Name:WANG-HARRIS
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:210 BOB WALLACE AVE SW
Mailing Address - Street 2:
Mailing Address - City:HUNTSVILLE
Mailing Address - State:AL
Mailing Address - Zip Code:35801-3809
Mailing Address - Country:US
Mailing Address - Phone:256-539-3454
Mailing Address - Fax:256-539-3478
Practice Address - Street 1:1716 UNIVERSITY BLVD
Practice Address - Street 2:G080A
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35294-0010
Practice Address - Country:US
Practice Address - Phone:205-975-2020
Practice Address - Fax:205-934-6755
Is Sole Proprietor?:Yes
Enumeration Date:2006-02-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALS916TA402152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ALU75161Medicare UPIN