Individual
JACQUELYN WANG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
4175 S GRAND CANYON DR STE 105, LAS VEGAS, NV 89147-7155
(702) 912-4254
(702) 847-7624
Mailing address
4175 S GRAND CANYON DR STE 105, LAS VEGAS, NV 89147-7155
(702) 912-4254
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
Primary
1124
NV
152W00000X
Optometrist
15226TLG
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1215319496
—
CA
Enumeration date
06/24/2015
Last updated
01/05/2026
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