Basic Information
| Provider Information | |||||||||
| NPI: | 1306837562 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WANG | ||||||||
| FirstName: | CATHERINE | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 160 BOSTON AVE | ||||||||
| Address2: | |||||||||
| City: | ALTAMONTE SPRINGS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 327014706 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4077757654 | ||||||||
| FaxNumber: | 4078346082 | ||||||||
| Practice Location | |||||||||
| Address1: | 10131 W COLONIAL DR | ||||||||
| Address2: | SUITE 201 | ||||||||
| City: | OCOEE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 347614221 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4078347776 | ||||||||
| FaxNumber: | 4078340973 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/04/2005 | ||||||||
| LastUpdateDate: | 05/05/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | ME88090 | FL | Y | Allopathic & Osteopathic Physicians | Ophthalmology | 207WX0009X | ME88090 | FL | N |
ID Information
| ID | Type | State | Issuer | Description | 268390300 | 05 | FL | MEDICAID | BW8414079 | 01 | FL | DEA# | OTHER |