Provider Demographics
NPI:1588779557
Name:WENG, VIVIAN M (OD)
Entity type:Individual
Prefix:DR
First Name:VIVIAN
Middle Name:M
Last Name:WENG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:DR
Other - First Name:VIVIAN
Other - Middle Name:M
Other - Last Name:DING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:OD
Mailing Address - Street 1:2191 MOWRY AVE STE 500F
Mailing Address - Street 2:FREMONT
Mailing Address - City:FREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:94538-1725
Mailing Address - Country:US
Mailing Address - Phone:510-742-1004
Mailing Address - Fax:510-742-1013
Practice Address - Street 1:2191 MOWRY AVE STE 500F
Practice Address - Street 2:FREMONT
Practice Address - City:FREMONT
Practice Address - State:CA
Practice Address - Zip Code:94538-1725
Practice Address - Country:US
Practice Address - Phone:510-742-1004
Practice Address - Fax:510-742-1013
Is Sole Proprietor?:No
Enumeration Date:2006-08-20
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA11492T152WC0802X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management