Provider Demographics
NPI:1548326168
Name:WANG, LAWRENCE (OD)
Entity type:Individual
Prefix:DR
First Name:LAWRENCE
Middle Name:
Last Name:WANG
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:PO BOX 33849
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89133-3849
Mailing Address - Country:US
Mailing Address - Phone:702-336-3493
Mailing Address - Fax:
Practice Address - Street 1:7090 N DURANGO DR
Practice Address - Street 2:STE 110
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89149-4494
Practice Address - Country:US
Practice Address - Phone:702-220-3937
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2010-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV0392152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV100502419Medicaid
NVV100842Medicare ID - Type Unspecified
NVV100843Medicare UPIN