Provider Demographics
NPI:1891799672
Name:HSIEH, WING C (OD)
Entity type:Individual
Prefix:DR
First Name:WING
Middle Name:C
Last Name:HSIEH
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 BANNOCK ST
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80204-4597
Mailing Address - Country:US
Mailing Address - Phone:303-436-4949
Mailing Address - Fax:303-602-4560
Practice Address - Street 1:777 BANNOCK ST
Practice Address - Street 2:
Practice Address - City:DENVER
Practice Address - State:CO
Practice Address - Zip Code:80204-4597
Practice Address - Country:US
Practice Address - Phone:303-436-4949
Practice Address - Fax:303-602-4560
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2025-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA1894152W00000X
COOPT.0003661152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD9201419Medicaid
SD9201730Medicaid
NE10025032100Medicaid
NE46044447400Medicaid
SD9201415Medicaid
MN130025300Medicaid
SD9201417Medicaid
SD9201418Medicaid
IA8280081Medicaid
IA6280081Medicaid
IA9280081Medicaid
NE46044447400Medicaid
SD9201730Medicaid
SD102330Medicare PIN
IA8280081Medicaid
SD9201418Medicaid